International Journal of Nephrology and Renovascular Disease最新文献

{"title":"Predictive Molecular Biomarkers in Pediatric Steroid-Resistant Nephrotic Syndrome: A Systematic Review.","authors":"Aqilah Hanifah Putri, Galuh Anindya Rahmah, Renata Oktavia Safitri, Ahmedz Widiasta, Yunisa Pamela","doi":"10.2147/IJNRD.S612205","DOIUrl":"https://doi.org/10.2147/IJNRD.S612205","url":null,"abstract":"<p><p>Nephrotic syndrome is the leading cause of pediatric chronic kidney disease, particularly the steroid-resistant subtype (SRNS). The current diagnostic paradigm relies on prolonged steroid trials or invasive biopsies, often delaying optimal treatment. This study systematically synthesizes evidence from cohort studies on non-invasive molecular biomarkers predicting SRNS at onset. We searched PubMed, Scopus, ScienceDirect, and MEDLINE Ultimate via EBSCO for cohort studies published between January 2015 and September 2025. The study protocol was registered with PROSPERO (CRD420251147997), and quality was assessed using the Newcastle-Ottawa Scale. Eleven studies comprising 718 study-level participant observations were included; as two studies originated from an overlapping cohort within a single research group, the number of unique children is likely lower. Candidate molecular signatures were identified across plasma proteins, cytokines, metabolites, urinary markers, transcriptomic markers, and a genetic/epigenetic model. Multi-marker panels showed high predictive utility, including a plasma protein panel (VDB+ADIPOQ+MMP2; AUC 0.780; P = 0.003) and a cytokine panel (IL-7+IL-9+MCP-1; AUC 0.846; sensitivity 64.3%; specificity 84.6%). Among individual markers, TGF-β2 mRNA showed the highest predictive accuracy (AUC 0.972; P < 0.001) in a small single cohort, followed by plasma glutamine in an age-combined model (AUC 0.810; OR 1.01), while reduced plasma malonate showed predictive value in children older than 3 years (AUC 0.84; OR 0.94). Conversely, urinary VDBP failed to distinguish SRNS from SSNS (P = 0.417), suggesting possible confounding by proteinuria severity. These exploratory findings suggest that several molecular biomarkers, particularly composite panels, may hold promise for future early risk stratification; however, given the small number and size of cohorts, participant overlap, and methodological heterogeneity, these results should be interpreted as hypothesis-generating rather than evidence of superiority of any single biomarker class, requiring validation in larger, independent, prospective cohorts before clinical application.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"612205"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109522","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":"Atypical Vasculitis Phenotype with Concomitant Medium- and Small-Vessel Involvement: A Case Report Highlighting Diagnostic and Pathological Challenges.","authors":"Roland Fejes, László Kovács, Dóra Bajcsi, Zsófia Balajthy, Denisia Suzana Todor, Béla Iványi, Szilárd Burcsár","doi":"10.2147/IJNRD.S631443","DOIUrl":"10.2147/IJNRD.S631443","url":null,"abstract":"<p><p>Systemic vasculitis is traditionally classified according to the predominant size of affected vessels; however, phenotypes affecting multiple vascular calibers may not be adequately captured by rigid definitions and require integrated clinicopathological interpretation. Here we report the case of a 70-year-old Caucasian man who presented with persistent systemic inflammation initially suggestive of infection. Although inflammatory markers decreased during antibiotic therapy, residual inflammation persisted, and the subsequent clinical course was characterized by myalgia, pulmonary involvement, and lymphadenopathy. Muscle biopsy revealed noninflammatory myopathic changes, consistent with normal creatine kinase levels. Following the initiation of corticosteroid therapy, the patient rapidly developed purpura and acute nephritic syndrome. Kidney biopsy demonstrated IgA glomerulonephritis (Oxford scores: M0, E0, S0, T0, and C1), interpreted as a manifestation of IgA vasculitis (IgAV), along with sclerosing phase of necrotizing arteritis involving arcuate arteries. These findings demonstrated the coexistence of IgA-mediated glomerular/small-vessel manifestations and chronic medium-vessel arterial pathology but did not establish the exact pathological process leading to the clinical manifestation. Treatment with corticosteroids and cyclophosphamide resulted in rapid clinical remission. This case illustrates a diagnostically challenging vasculitis phenotype involving different vascular compartments that cannot be assigned to a single conventional category. The case highlights the importance of integrated clinicopathological correlation and detailed histopathological assessment in resolving diagnostic uncertainty and guiding immunosuppressive therapy. Recognition of vasculitis as a dynamic disease spectrum rather than a rigidly compartmentalized entity is essential for timely diagnosis and optimal management.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"631443"},"PeriodicalIF":2.3,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038491","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":"Construction of a Machine Learning-Based Risk Prediction Model for Drug-Induced Acute Kidney Injury in Elderly Patients.","authors":"Xiayan Xu, Haoting Huang, Yan Xu, Ying Liu, Jiamei Yi, Qingrong Zou, Jianru Wu, Xiaoyu Liu","doi":"10.2147/IJNRD.S586464","DOIUrl":"10.2147/IJNRD.S586464","url":null,"abstract":"<p><strong>Background: </strong>Elderly individuals are particularly vulnerable to drug-induced acute kidney injury (DI-AKI) due to their distinct physiological and pathophysiological traits. DI-AKI's non-specific symptoms complicate the identification of causative medications, highlighting the urgent need for accurate predictive tools to detect AKI risk early in this group.</p><p><strong>Aim: </strong>The objective is to construct a machine learning-based predictive model for DI-AKI in elderly patients utilizing real-world data, with the aim of offering a decision-support tool for the early clinical identification of DI-AKI risk.</p><p><strong>Methods: </strong>The electronic health records of 2,389 patients aged ≥60 years at Shenzhen Luohu People's Hospital from January 2023 to December 2024 were retrospectively analyzed. Drug-induced AKI was defined by KDIGO creatinine criteria (≥0.3 mg/dL within 48h or ≥1.5×baseline within 7d) plus Naranjo score for drug attribution. Forty optimal features (30 original and 10 interaction terms) were selected, and seven machine learning algorithms were assessed using nested cross-validation with different feature selection and interactive feature construction methods. SHAP values were employed for model interpretability.</p><p><strong>Results: </strong> In a study of 2,389 patients, 39.9% (953 individuals) experienced drug-induced AKI. The Random Forest model performed best on the test set, with an Area Under the Curve (AUC) of 0.9209 [95% CI: 0.896-0.946], showing 84.9% sensitivity, 89.1% specificity, and an 85.5% positive predictive value. Key predictors included a history of renal failure (importance score: 0.1703) and drug-disease interactions, such as those involving antihypertensives and renal failure (importance score: 0.1000).</p><p><strong>Conclusion: </strong> This machine learning model is capable of aiding in the identification of high-risk elderly patients within electronic medical record systems, with a particular emphasis on drug interactions and renal function as pivotal risk factors. By employing SHAP values for analysis, this study elucidates the contributions of these risk factors and offers support for making personalized medication decisions; However, external validation remains necessary prior to clinical implementation.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"586464"},"PeriodicalIF":2.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963064","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 the Modified Furosemide Response Index and Prognosis in Patients with Chronic Kidney Disease: A Retrospective Cohort Study Based on the MIMIC-IV Database.","authors":"Zhibin Chen, Guobao Hong, Hua Xiao, Qiaobin Wu, Kai Liu","doi":"10.2147/IJNRD.S635818","DOIUrl":"10.2147/IJNRD.S635818","url":null,"abstract":"<p><strong>Background: </strong>The modified furosemide response index (mFRI), derived from a standardized furosemide stress test, is a biomarker of diuretic responsiveness and AKI progression. Its prognostic value in chronic kidney disease (CKD) remains unclear. This study examined the association between mFRI and clinical outcomes in critically ill patients with CKD.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the MIMIC‑IV database. Critically ill CKD patients receiving furosemide were included. Restricted cubic splines were used to examine the non‑linear relationship between mFRI and mortality. Patients were grouped by mFRI quartiles. Multivariable Cox and logistic regression assessed outcome associations, with subgroup analyses for robustness.</p><p><strong>Results: </strong>Among 3,311 patients, a significant L‑shaped non‑linear association was observed between mFRI and 28‑day mortality (P < 0.001). Mortality risk declined sharply as mFRI increased to 0.143, then plateaued. Kaplan‑Meier analysis showed progressively lower mortality from the lowest (Q1) to the highest (Q4) mFRI quartile. Higher mFRI quartiles were associated with lower all‑cause mortality and reduced use of renal replacement therapy.</p><p><strong>Conclusion: </strong>mFRI has a non‑linear, L‑shaped association with prognosis in critically ill patients with CKD. Because it is simple, low‑cost, and repeatable, mFRI could be a practical bedside tool for risk stratification in this population.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"635818"},"PeriodicalIF":2.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900493","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 Clinicopathological Features and Outcomes Between Kidney-Limited and Systemic Thrombotic Microangiopathy: A Study Based on a Semiquantitative Pathological Scoring System.","authors":"Yan Pan, Yongxin Zhao, Xi Li, Xueping Wu, Bowen Chen, Mengru Lu, Rubing Shen, WeiDong Chen, Lei Liu","doi":"10.2147/IJNRD.S604159","DOIUrl":"10.2147/IJNRD.S604159","url":null,"abstract":"<p><strong>Objective: </strong>To systematically compare the clinicopathological features and prognostic outcomes of renal-limited thrombotic microangiopathy (RL-TMA) and systemic thrombotic microangiopathy (Sys-TMA) using a semiquantitative pathological scoring system.</p><p><strong>Methods: </strong>We retrospectively analyzed 47 patients with biopsy-proven TMA between 2018 and 2025, categorized as RL-TMA (n = 42) or Sys-TMA (n = 5) based on systemic manifestations. Clinical, pathological, and follow-up data were collected. A composite renal endpoint served as the primary outcome. Kaplan-Meier and Cox regression analyses were used for survival analysis and prognostic factor identification.</p><p><strong>Results: </strong>RL-TMA patients were older, with higher hemoglobin and platelet levels, lower lactate dehydrogenase, less complement C3 consumption, and significantly fewer multiorgan dysfunctions than Sys-TMA patients. Pathologically, Sys-TMA was dominated by acute microvascular lesions, whereas RL-TMA showed more chronic changes (glomerulosclerosis, arteriolar hyalinosis) and more frequent immune complex deposition. Total immunofluorescence intensity and IgG, IgG2, IgG4, and C1q deposition were significantly higher in RL-TMA (all P < 0.05). Over a median follow-up of 16-20 months, end-stage kidney disease incidence did not differ significantly between groups (9.5% vs 0%, P > 0.05). In RL-TMA, univariate analysis showed that lower hemoglobin was associated with worse renal outcomes (HR = 0.946, P = 0.004). Serum albumin showed no clear association (HR = 0.992, P = 0.862), while pathological scores lacked independent predictive value. Kaplan-Meier analysis showed no statistically significant difference in renal progression-free survival between the two groups (P = 0.97).</p><p><strong>Conclusion: </strong>This study delineates significant differences between RL-TMA and Sys-TMA across clinical, pathological, and prognostic dimensions, suggesting that RL-TMA may represent a distinct clinicopathological entity, warranting further validation in larger prospective studies. Given the small sample size of the Sys-TMA group, these results should be interpreted as exploratory and hypothesis-generating. Hemoglobin levels showed an association with renal outcomes in univariate analysis, but this finding requires further investigation in larger cohorts before any clinical utility can be established.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"604159"},"PeriodicalIF":2.3,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887497","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":"Machine Learning-Based Prediction of Hemoglobin Variability in Patients with Chronic Kidney Disease Receiving Erythropoiesis-Stimulating Agents: A Real-World Retrospective Study.","authors":"Pattanan Buranasaksathien, Wanjak Pongsittisak, Padoemwut Teerawongsakul, Solos Jaturapisanukul, Thananda Trakarnvanich, Sathit Kurathong","doi":"10.2147/IJNRD.S627208","DOIUrl":"10.2147/IJNRD.S627208","url":null,"abstract":"<p><strong>Background: </strong>Anemia is a common complication of chronic kidney disease (CKD) and is predominantly managed with erythropoiesis-stimulating agents (ESAs). Hemoglobin response to ESA therapy varies substantially among patients and remains difficult to predict owing to multiple interacting clinical and treatment-related factors. Machine learning approaches may help model hemoglobin dynamics using routinely collected clinical data.</p><p><strong>Purpose: </strong>To develop and evaluate machine learning models for predicting weekly hemoglobin changes in patients with CKD receiving ESA therapy.</p><p><strong>Patients and methods: </strong>A retrospective cohort study was conducted using electronic medical records from a tertiary care center in Thailand (January 2012 to December 2022). Adult patients with CKD stages 3B-5 and an estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73 m² receiving ESA therapy were included. Four machine learning algorithms (Decision Tree, Random Forest, XGBoost, and Support Vector Machine) were trained using data from 80% of patients and evaluated on an independent test set comprising the remaining 20% of patients, with all longitudinal observations from each patient kept within the same partition. Performance was assessed using root mean square error (RMSE) and Pearson correlation coefficient.</p><p><strong>Results: </strong>A total of 834 patients contributing 10,335 clinical visits and 9,935 time-series observations were included. The median age was 71 years and 58.6% were female. RMSE values were 0.121, 0.115, 0.117, and 0.115 for Decision Tree, Random Forest, XGBoost, and Support Vector Machine, respectively. Pearson correlation coefficients ranged from 0.457 to 0.553 (all p < 0.001).</p><p><strong>Conclusion: </strong>Machine learning models trained on routinely collected clinical data showed feasibility for predicting short-term hemoglobin variability in patients with CKD receiving ESA therapy. Larger multicenter and external validation studies are needed to refine predictive accuracy and evaluate clinical utility.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"627208"},"PeriodicalIF":2.3,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880442","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":"Cardiovascular Mortality and Its Risk Factors in Patients on Twice-Weekly Maintenance Hemodialysis: An 18-Month Retrospective Cohort Study from a Tertiary Center in Indonesia.","authors":"Ria Bandiara, Hensen Soetikno, Davin Takaryanto, Rizky Andhika, Lilik Sukesi, Afiatin Makmun, Rudi Supriyadi","doi":"10.2147/IJNRD.S624322","DOIUrl":"10.2147/IJNRD.S624322","url":null,"abstract":"<p><strong>Background: </strong>Patients on maintenance hemodialysis (MHD) face cardiovascular mortality far exceeding that of the general population, yet the evidence on risk factors comes overwhelmingly from thrice-weekly cohorts. In Indonesia and many low- and middle-income countries, twice-weekly hemodialysis is the standard regimen funded by national insurance, and the risk factor profile of this underdialysed population has received little attention.</p><p><strong>Objective: </strong>To identify independent risk factors for cardiovascular mortality among Indonesian adults receiving twice-weekly MHD.</p><p><strong>Methods: </strong>We analysed the complete eligible population of 162 adults receiving twice-weekly MHD (8-10 hours/week) at a tertiary center in Bandung, followed for 18 months (May 2018-November 2019). Baseline variables were drawn from the unit's REDCap database. Severe hypoalbuminemia was defined as serum albumin ≤3.0 g/dL. Seven variables with bivariate p<0.25 entered modified Poisson regression with robust standard errors to estimate adjusted relative risks (aRR); dialysis vintage was entered in addition on clinical grounds. Model stability was assessed across progressively more parsimonious specifications.</p><p><strong>Results: </strong>Mean age was 49.7 ± 14.2 years, 47% were men, and cardiovascular events accounted for 92.1% of the 38 deaths. Eighteen-month cardiovascular mortality was 21.6% (35/162); 1-year survival was 80.7%. Six factors were independently associated with cardiovascular death: age >60 years (aRR 3.15, 95% CI 1.65-6.02), Kt/V <1.8 (aRR 2.52, 95% CI 1.35-4.69), diabetic kidney disease (aRR 2.05, 95% CI 1.16-3.63), hyperphosphatemia (aRR 1.94, 95% CI 1.12-3.35), abnormal serum potassium (aRR 1.91, 95% CI 1.09-3.34), and dialysis vintage >60 months (aRR 1.69, 95% CI 1.01-2.81). Age and Kt/V remained significant across all model specifications. Serum albumin discriminated poorly (AUC 0.587); the ≤3.0 g/dL cutoff is reported as exploratory.</p><p><strong>Conclusion: </strong>Older age, inadequate dialysis dose, diabetic etiology, hyperphosphatemia, dyskalemia, and prolonged vintage were independently associated with cardiovascular mortality, with age and dialysis dose the most robust. The findings argue for closer attention to dialysis adequacy and mineral metabolism in reduced-frequency programs.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"624322"},"PeriodicalIF":2.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818371","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":"Progressive Human Orf Virus Infection in a Kidney Transplant Recipient Successfully Treated with Cryotherapy Without Modification of Immunosuppression: A Case Report.","authors":"Samreen M Rahmoon, Leen M AbuAfifeh, Osama A Alkhalidi, Farooq Ahmad, Gamal B S Alfitori","doi":"10.2147/IJNRD.S604203","DOIUrl":"https://doi.org/10.2147/IJNRD.S604203","url":null,"abstract":"<p><p>Human orf is a zoonotic parapoxvirus infection that is typically self-limiting with resolution in 3-6 weeks but may cause severe disease in immunocompromised patients. We report a kidney transplant recipient who developed a rapidly progressive fingertip lesion following contact with raw meat during Eid al-Adha. Initial misdiagnosis and surgical excision were followed by marked lesion progression, mimicking a vascular tumor. Histopathology confirmed orf virus infection. However, PCR testing was not done as the test was not available. Topical imiquimod was not initiated due to an active wound. Weekly liquid nitrogen cryotherapy as monotherapy resulted in complete resolution after nine sessions without recurrence. Further modifications/reduction in immunosuppressive medication was not needed. This case highlights cryotherapy as a potential treatment option for orf infection in transplant recipients.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"604203"},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759277","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":"Spatiotemporal Trends in Chronic Kidney Disease Mortality and Its Association with Low Temperature in the United States (1999-2023).","authors":"Heng Wang, Keyi Fan, Limin Cao, Guoping Zheng","doi":"10.2147/IJNRD.S602592","DOIUrl":"10.2147/IJNRD.S602592","url":null,"abstract":"<p><strong>Purpose: </strong>Chronic kidney disease (CKD) is a major public health concern in the United States, with persistently rising incidence and mortality. This study aimed to quantify geographic and demographic disparities in CKD mortality across the United States and to examine the association between CKD mortality and ambient temperature variation.</p><p><strong>Patients and methods: </strong>CKD deaths and age-adjusted mortality rates (AAMRs) for 1999-2023 were obtained from CDC WONDER and stratified by census region, state, sex, race, age group, and urbanization level. Mortality trends were quantified using joinpoint regression. Primary temperature-mortality analyses used CDC WONDER-linked NLDAS temperature data for 1999-2011, while supplementary descriptive analyses used independently retrieved NLDAS temperature estimates for 2012-2023. Temperature-mortality associations were evaluated using Spearman rank correlations, quasi-Poisson regression models, and distributed lag nonlinear models (DLNMs).</p><p><strong>Results: </strong>From 1999 to 2023, 628,937 CKD deaths occurred, with national AAMR increasing steadily. Mortality rates were consistently higher in men and nonmetropolitan areas. AAPC rose fastest in the West and Midwest, though recent AAMR declines were noted in the Northeast and South. Winter mortality exceeded summer across regions. In the primary DLNM analysis, cold exposure at the region-specific 5th percentile was associated with higher cumulative CKD mortality risk, with risk ration (RR) ranging from 1.065 in the Northeast to 1.505 in the Midwest; the association reached statistical significance only in the Midwest (RR 1.505, 95% CI: 1.091-2.075), while hot-exposure estimates at the 95th percentile were generally imprecise and not statistically significant.</p><p><strong>Conclusion: </strong>CKD mortality in the United States increased from 1999 to 2023 with marked geographic and demographic disparities. Cold air temperature was associated with higher short-term mortality risk.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"602592"},"PeriodicalIF":2.3,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701244","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":"Efficacy of Patiromer in Treatment of Long Inter-Dialytic Interval Hyperkalemia in Potassium-Rich Diet Populations Undergoing Intermittent Hemodialysis.","authors":"Bilal Mohsin, Abdullah Abdulaziz Althobaiti, Joudi T Alattas, Joynalyn E Barrios, Wafa A Altuwaijri, Akber Saifullah, Shroug Al Harbi, Lama Hefni, Wael Habhab, Najla Zabani","doi":"10.2147/IJNRD.S609353","DOIUrl":"10.2147/IJNRD.S609353","url":null,"abstract":"<p><strong>Background: </strong>Hyperkalemia after a Long Interdialytic Interval (LIDI) is a potentially life-threatening complication in patients undergoing intermittent hemodialysis. The risk is exacerbated especially in populations known for Potassium-rich dietary habits and cultural tradition of weekend gatherings. Patiromer is a potassium binder that helps treat Hyperkalemia. This study aimed to evaluate the efficacy of Patiromer in the management of LIDI Hyperkalemia in patients with ESKD on Intermittent Hemodialysis, with Potassium rich dietary habits as in Saudi Arabia.</p><p><strong>Methods: </strong>Adult patients who had completed 3 months on Intermittent Hemodialysis, were screened for LIDI hyperkalemia pre dialysis (serum K >5.3 mmol/L).Patients with hyperkalemia were prescribed Patiromer on days off Hemodialysis during the LIDI (Thursday and Friday for Saturday group; Friday and Saturday for Sunday group). Pre HD serum potassium levels were monitored after the LIDI at weeks 1, 2, 4, 8, 12, 24, and 52. Patient Compliance was ensured through telephonic communication with the patient or the care giver.</p><p><strong>Results: </strong>Among the 127 patients on Intermittent Hemodialysis, 58 were identified with LIDI hyperkalemia out of whom 52 patients completed one year follow-up. 36 had serum K 5.3-5.9 mmol/l, 11 had serum K 6-6.5 mmol/l, 5 had serum K 6.5 mmol/l and above. Patiromer therapy resulted in a mean serum potassium reduction of 0.8-2.5 mmol/L, with a sustained average reduction of 1.57 mmol/L observed over 52 weeks. The treatment was well tolerated, with no drop outs reported due to side effects.</p><p><strong>Conclusion: </strong>Patiromer demonstrated sustained efficacy and excellent tolerance in preventing hyperkalemia after the LIDI in our potassium rich diet population undergoing Intermittent Hemodialysis.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"609353"},"PeriodicalIF":2.3,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701281","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}