Journal of Nephrology最新文献

{"title":"Development and validation of a prediction model for 90-day mortality among critically ill patients with AKI undergoing CRRT.","authors":"Tingting Wang, Sha Xu, Yufei Yuan, Wenbin Guo, Hongliang Zhang, Jiajun Sun","doi":"10.1007/s40620-025-02237-1","DOIUrl":"https://doi.org/10.1007/s40620-025-02237-1","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is frequent among intensive care unit (ICU) patients and is linked with high morbidity and mortality. In the absence of specific pharmacological treatments for AKI, continuous renal replacement therapy (CRRT) is a primary treatment option. This study aimed to develop and validate a predictive model for 90-day mortality in critically ill patients with AKI undergoing CRRT.</p><p><strong>Methods: </strong>Clinical data from DATADRYAD were used. We randomly divided 1121 adult patients receiving CRRT for AKI into training (80%, n = 897) and validation (20%, n = 224) cohorts. A nomogram prediction model was developed using Cox proportional hazards regression with the training set, and was validated internally. Model performance was evaluated based on calibration, discrimination, and clinical utility.</p><p><strong>Results: </strong>The model, incorporating seven predictors-SOFA score, serum creatinine, blood urea nitrogen, albumin levels, Charlson comorbidity index, mean arterial pressure at CRRT initiation, and phosphate levels 24 h after CRRT initiation-demonstrated robust performance. It achieved a C-index of 0.810 in the training set and 0.794 in the validation set.</p><p><strong>Conclusions: </strong>We developed and validated a predictive model based on seven key clinical predictors, showing excellent performance in identifying high-risk patients for 90-day mortality in AKI patients undergoing CRRT.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acid-base implications of the Gibbs-Donnan effect during continuous veno-venous hemofiltration.","authors":"Francesco Zadek, Beatrice Brunoni, Francesca Mulazzani, Irene Sironi, Stefania Paccagnini, Maria Luisa De Angelis, Roberto Fumagalli, Thomas Langer","doi":"10.1007/s40620-025-02238-0","DOIUrl":"https://doi.org/10.1007/s40620-025-02238-0","url":null,"abstract":"<p><strong>Background: </strong>This in-vitro and in-vivo study investigates the Gibbs-Donnan effect across the filter during continuous veno-venous hemofiltration (CVVH). In particular, we assessed its acid-base implications, applying the physical-chemical approach.</p><p><strong>Methods: </strong>A prospective, single-center study was conducted using the PrismaMax machine (Baxter). Two sets of in-vitro CVVH experiments (with and without albumin) were performed to quantify the Gibbs-Donnan effect. Electrolytes, glucose, and osmolarity changes were measured across the filter and in the ultrafiltrate. Strong ion difference and sieving coefficients of the main solutes were calculated. Similar measurements were performed in oligo-anuric critically ill patients undergoing CVVH.</p><p><strong>Results: </strong>In-vitro experiments without albumin showed a sieving coefficient of 1 for both positive and negative ions. On the contrary, when albumin was added, the sieving coefficient for sodium and chloride changed linearly with albumin concentration (r = -0.94, p < 0.001 for sodium, r = 0.88, p < 0.001 for chloride), resulting in a progressive linear increase in post-filter strong ion difference (β = 1.1, r = 0.77, p = 0.003). In 22 studied patients, calculated albumin concentration increased across the filter (2.2 ± 0.5 g/dL vs. 3.1 ± 0.7 g/dL), leading to sodium retention (138 ± 6 vs. 141 ± 6 mmol/L, p < 0.001) and chloride excretion (100 ± 5 vs. 97 ± 5 mmol/L, p < 0.001), thus resulting in a higher post-filter strong ion difference (46 ± 4 vs. 40 ± 4 mmol/L, p < 0.001).</p><p><strong>Conclusions: </strong>These in-vitro and in-vivo studies demonstrate that albumin linearly affects the sieving coefficient of ions, increasing the strong ion difference of plasma water during its passage through the filter and thus having a systemic alkalizing effect.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and clinical outcomes of pregnancy-related acute kidney injury (PrAKI) in preeclampsia-complicated pregnancies in Saudi Arabia: a single-center experience.","authors":"Ghada Ankawi, Duaa M Bahkali, Abdullah Alghamdi, Reem Alghamdi, Raghad Alsaaedi, Nedaa Bahkali","doi":"10.1007/s40620-025-02258-w","DOIUrl":"https://doi.org/10.1007/s40620-025-02258-w","url":null,"abstract":"<p><strong>Background: </strong> Hypertensive disorders of pregnancy are a leading cause of pregnancy-related acute kidney injury. Data on preeclampsia-complicated pregnancies in the Saudi population are limited.</p><p><strong>Methods: </strong>This retrospective, single-center study analyzed preeclampsia-complicated pregnancies from January 2020 to December 2022, excluding those with chronic kidney disease. Baseline variables collected included age, ethnicity, body mass index, comorbidities, parity, antenatal care, use of in vitro fertilization, and multiple gestation pregnancies. Study outcomes included: 1. Pregnancy-related acute kidney injury incidence, defined as a serum creatinine > 77 µmol/L during pregnancy or an increase > 26.5 µmol/L within six weeks postpartum; 2. Comparison of fetomaternal outcomes between pregnancy-related acute kidney injury and non- pregnancy-related acute kidney injury groups; and 3. Pregnancy-related acute kidney injury risk factors.</p><p><strong>Results: </strong>Pregnancy-related acute kidney injury occurred in 25 (19.4%) of the 129 preeclampsia-complicated pregnancies. It was significantly associated with adverse fetal outcomes, including higher rates of preterm birth (72% vs. 45.2%, P = 0.016), lower birth weight (1500 g vs. 2277.5 g, P = 0.002), intrauterine growth restriction (36% vs. 14.4%, P = 0.013), and intrauterine fetal death (28% vs. 8.7%, P = 0.008). However, no significant differences were observed in maternal outcomes. Independent predictors of pregnancy-related acute kidney injury included preexisting diabetes mellitus (Odds Ratio [OR] 3.534, P = 0.048), Hemolysis, Elevated Liver enzymes, and Low Platelet count. syndrome (OR 25.250, P = 0.004), and intrauterine fetal death (OR 4.105, P = 0.013). Antenatal care was associated with a reduced risk of pregnancy-related acute kidney injury (OR 0.196, P = 0.033).</p><p><strong>Conclusions: </strong>pregnancy-related acute kidney injury is a common complication in preeclampsia-complicated pregnancies and is associated with poor fetal outcomes. Early identification and provision of antenatal care can significantly reduce the risk of pregnancy-related acute kidney injury.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lead intoxication in end-stage kidney disease: a lesson for the clinical nephrologist.","authors":"Shikha Shailly, Jay Hawkins, Ronald Kirschner, Felipe S Naranjo","doi":"10.1007/s40620-025-02215-7","DOIUrl":"10.1007/s40620-025-02215-7","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic capillary leak syndrome: a nosological entity that the nephrologist must be aware of.","authors":"Carlo Basile","doi":"10.1007/s40620-025-02250-4","DOIUrl":"10.1007/s40620-025-02250-4","url":null,"abstract":"<p><p>Capillary leak syndrome occurs when plasma leaks out of capillaries into muscles, tissues, organs and body cavities. There are two major types of capillary leak syndrome: 1. secondary capillary leak syndrome: it is a single episode triggered by another disease, condition or drug; 2. idiopathic systemic capillary leak syndrome: it is a rare disease characterized by recurrent episodes of acute life-threatening episodes of shock, hemoconcentration, and hypoalbuminemia. An increase in capillary permeability results in reversible plasma movement into the interstitial spaces followed by the appearance of related symptoms or complications, including acute kidney injury. Cytokines are likely to be important in the pathophysiology of systemic capillary leak syndrome. Fluid management is a critical part of the treatment of systemic capillary leak syndrome: hypovolemia and hypotension can cause organ injury, whereas capillary leakage of administered fluid can worsen organ edema leading to progressive organ injury.Although systemic capillary leak syndrome is a rare entity, it can be life-threatening. The nephrologist must be aware of the potential and serious complications linked to this pathology, including the need for kidney replacement therapy. This review aims to increase awareness of systemic capillary leak syndrome in the nephrology community.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic kidney disease awareness: a cross-sectional study in primary care settings in Türkiye.","authors":"Esra Gök, Mustafa Kürşat Şahin","doi":"10.1007/s40620-025-02210-y","DOIUrl":"10.1007/s40620-025-02210-y","url":null,"abstract":"<p><strong>Background: </strong>Raising awareness of chronic kidney disease (CKD) is essential for early detection and prevention, since the condition remains largely underdiagnosed, particularly in primary care settings. The present study aimed to evaluate awareness levels regarding the causes and symptoms of CKD among individuals receiving primary care.</p><p><strong>Methods: </strong>This cross-sectional study included 457 participants recruited from two primary care centers in Türkiye using systematic random sampling. The data were collected via face-to-face interviews using a pre-tested questionnaire between April and June 2023. Awareness levels were classified using Bloom's cutoff points-high awareness (≥ 80%), moderate awareness (60-79%), and low awareness (< 60%).</p><p><strong>Results: </strong>The mean age of the participants was 42.3 ± 14.9 years. The study population consisted of 55.4% women, 51.2% of the participants were aged 18-39, 74.6% were married, and 53.4% held at least a university bachelor's degree. As for CKD awareness, 64.1% were aware that CKD can be caused by pain medication, 56% that it can be caused by hypertension, and 48.8% that it can result from diabetes. Additionally, 58.6% were aware that swelling of the feet and ankles can represent a symptom of CKD. Awareness of the causes and symptoms of CKD was low in 78.6% of our participants (n = 359), moderate in 17.5% (n = 80) and high in 3.9% (n = 18). Individuals who recalled having been informed about these causes and symptoms by their primary care physicians exhibited higher awareness. No significant differences in awareness were observed across different sociodemographic groups. A positive correlation was observed between awareness of the causes of CKD and awareness of its symptoms.</p><p><strong>Conclusions: </strong>Awareness of CKD causes and symptoms among the participants was limited, nearly half being unaware of key risk factors such as painkiller use, obesity, hypertension, smoking, diabetes, and herbal product use. Increased education, particularly by primary care physicians, may improve awareness and early detection rates.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of C3-exclusive deposits in post-infectious glomerulonephritis in adults: an observational cohort in Tunisia.","authors":"Nouha Ben Mahmoud, Wissal Sahtout, Faten Ghabi, Mariem Ben Salem, Habib Skhiri","doi":"10.1007/s40620-025-02262-0","DOIUrl":"https://doi.org/10.1007/s40620-025-02262-0","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting 3-year all-cause mortality in patients undergoing hemodialysis using machine learning.","authors":"Aiko Okubo, Toshiki Doi, Kenichi Morii, Yoshiko Nishizawa, Kazuomi Yamashita, Kenichiro Shigemoto, Sonoo Mizuiri, Tetsuji Arakawa, Michiko Arita, Takayuki Naito, Takao Masaki","doi":"10.1007/s40620-025-02236-2","DOIUrl":"https://doi.org/10.1007/s40620-025-02236-2","url":null,"abstract":"<p><strong>Background: </strong>Survival rates for patients after starting hemodialysis (HD) remain low, and cardiovascular events remain the most common cause of death. However, few reports have investigated risk models that include electrocardiogram (ECG) findings. The present study aimed to develop a novel risk model including ECG findings for predicting all-cause death in patients undergoing HD.</p><p><strong>Methods: </strong>We enrolled 454 patients undergoing HD at 4 facilities from April 2008 to March 2021. Multivariate Cox regression analysis was performed to identify predictive factors, which were used to create a nomogram. We calculated the area under the curve (AUC) and used calibration plots to evaluate the risk model. Bootstrapping was also performed to evaluate the relationship between predicted and observed probabilities.</p><p><strong>Results: </strong>During the 3-year follow-up period, 98 (21.5%) patients died. Age (P < 0.001), serum albumin level (P = 0.03), history of stroke prior to HD initiation (P = 0.001), atrial fibrillation (P = 0.01), and corrected QT interval (P = 0.005) were identified as independent predictors of all-cause death. The predictive model was constructed using all these parameters with good discrimination of all-cause death, showing an AUC of 0.83 with 80.1% sensitivity and 75.6% specificity. The AUC based on the tenfold cross-validation was 0.82, with 78.2% sensitivity and 75.1% specificity, suggesting a good model.</p><p><strong>Conclusion: </strong>This novel risk model can effectively stratify high-risk patients and predict 3-year all-cause mortality in patients undergoing HD. We anticipated that this risk model might contribute to identify high-risk cases earlier and provide safer prescriptions and treatments for individual patients.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiopaque intestinal contents due to simultaneous ingestion of lanthanum carbonate and sodium zirconium cyclosilicate: a nephrology image.","authors":"Ole Hudowenz, Jonas Stroeder, Martin Nitschke","doi":"10.1007/s40620-024-02198-x","DOIUrl":"https://doi.org/10.1007/s40620-024-02198-x","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of secondary hyperparathyroidism in hemodialysis patients: a comparison between two Italian centers to evaluate real-world guideline implementation.","authors":"Fabio Malberti, Stefano Possenti, Paola Pecchini, Bernardo Lucca, Gianluca Marchi, Roberto Zubani, Giusy Chiarelli, Chiara Manenti, Marina Foramitti, Federico Alberici","doi":"10.1007/s40620-025-02227-3","DOIUrl":"https://doi.org/10.1007/s40620-025-02227-3","url":null,"abstract":"<p><strong>Background: </strong>Even though calcimimetics and active vitamin D are frequently used, studies using data from dialysis Registries have shown a progressive increase in parathyroid hormone (PTH) levels in the dialysis population over the last 20 years. In the relatively small sample of Italian patients included in the DOPPS phase 5 (n = 449), elevated or suppressed PTH levels were observed in 14% and 34% of patients, respectively. The aim of this study was to assess mineral metabolism parameters and treatment strategies in the hemodialysis population of two Centers in Northern Italy.</p><p><strong>Methods: </strong>We included all chronic hemodialysis patients treated between September and October 2023 at the Dialysis Centers of Cremona (n = 177) and Brescia (n = 315). Both Dialysis Units followed the KDIGO guidelines. However, differences in treatment strategies were noted. Patients in Brescia were systematically prescribed 25-OH vitamin D, while in Cremona, if 1-25 vitamin D was prescribed, 25-OH vitamin D was discontinued. In the Brescia Center, all patients used a 1.50 mmol/l calcium dialysate concentration, while in Cremona patients with hypercalcemia or suppressed PTH levels were prescribed a 1.25 mmol/l calcium dialysate concentration. Mineral metabolism parameters were evaluated and compared to KDIGO recommendations in both settings.</p><p><strong>Results: </strong>In the hemodialysis population considered, the prevalence of high (> 600 pg/ml) or suppressed (< 150 pg/ml) PTH levels was, 8.1% and 24%, respectively. Patients treated at the Brescia Center had significantly lower serum calcium and phosphate levels as compared to patients treated in Cremona. However, serum PTH and 25-vitamin D levels were higher in Brescia. In Brescia, native vitamin D was prescribed more frequently than in Cremona (81.9% vs 5.1%, p < 0.001). In Cremona, both active vitamin D and calcimimetics were prescribed more frequently than in Brescia (respectively, 62.1% and 50.9% vs 39.7% and 27.2%, p < 0.001). The prevalence of hypercalcemia (Brescia: 1.6%, Cremona: 1.7%), hypocalcemia (Brescia: 19%, Cremona: 16%), hyperphosphatemia (Brescia: 35%, Cremona: 40%), and elevated PTH levels (Brescia: 7.6%, Cremona: 9.0%) did not differ significantly. Suppressed PTH levels were more frequent in patients treated in Cremona (35% vs 20%, p < 0.001).</p><p><strong>Conclusions: </strong>Our study found, in the two clinical settings of the study, a lower prevalence of patients with elevated or suppressed PTH levels compared to the Italian patients included in DOPPS. Despite different treatment strategies, the prevalence of elevated PTH levels was similar in the two Centers. This suggests that different therapeutic strategies may be equally effective in controlling secondary hyperparathyroidism.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}