Journal of Nephrology最新文献

{"title":"Comparative efficacy of epoetin alfa vs. darbepoetin in children with chronic kidney disease: a systematic review, meta-analysis and cost-effectiveness analysis.","authors":"Nicola Bertazza Partigiani, Alessandro D'Uva, Serena Vigezzi, Alessandra Rosalba Brazzale, Enrico Vidal","doi":"10.1007/s40620-025-02303-8","DOIUrl":"https://doi.org/10.1007/s40620-025-02303-8","url":null,"abstract":"<p><strong>Background: </strong>Recombinant human erythropoietin (rHuEPO) and darbepoetin alfa (DA) are key treatments for anemia in individuals with chronic kidney disease (CKD), including children, but evidence comparing their efficacy in the pediatric population remains inconclusive.</p><p><strong>Methods: </strong>This systematic review, adhering to PRISMA guidelines, analyzed randomized controlled trials and observational studies comparing rHuEPO and DA in pediatric patients with CKD (≤ 18 years; ≥ 10 children per study), searched across medical databases and clinical trial registries until 31/12/2024. The Cochrane Risk of Bias was used for assessment. Meta-analysis evaluated hemoglobin (Hb) increase and cost-effectiveness using the incremental cost-effectiveness ratio.</p><p><strong>Results: </strong>From 1298 screened articles, 7 studies were included: 3 prospective studies, 2 randomized open-label non-inferiority trials, and 2 retrospective cohort studies, comprising 208 children for direct comparisons and 357 for transitioning studies. Meta-analysis found no significant Hb improvement differences between rHuEPO and DA after 21-28 weeks of treatment (DA + 0.15 g/dL, 95% CI - 0.22 to + 0.52). rHuEPO was more cost-effective than DA. Transitioning to DA increased Hb by + 0.93 g/dL (95% CI 0.53-1.33) in children with suboptimal levels, after 21-28 weeks of rHuEPO. The incremental cost-effectiveness ratio of switching to DA was ~ €340 per g/dL of Hb over 24 weeks.</p><p><strong>Conclusions: </strong>rHuEPO is the most cost-effective initial anemia treatment in pediatric CKD. However, transitioning to DA may be considered for patients who do not achieve adequate Hb response. The small number of randomized controlled trials (RCTs), variability in dose conversion, and study heterogeneity may limit generalizability.</p><p><strong>Prospero id: </strong>CRD42023460872.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988670","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":"KDIGO and the sick planet: a green nephrology controversy in a moment of contrasts.","authors":"Giorgina Barbara Piccoli, Nathan Berman Parks","doi":"10.1007/s40620-025-02309-2","DOIUrl":"https://doi.org/10.1007/s40620-025-02309-2","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022578","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":"Genetic and clinical features of familial Mediterranean fever in a cohort of patients with kidney failure.","authors":"Ahmed Sheyyab, Rania Wahdan, Anas Bani-Hani, Mohammad Al-Thnaibat, Mahmood Matalkah, Lubna Tahtamouni, Salem R Yasin","doi":"10.1007/s40620-025-02272-y","DOIUrl":"https://doi.org/10.1007/s40620-025-02272-y","url":null,"abstract":"<p><strong>Background: </strong>Familial Mediterranean fever (FMF) often manifests as recurrent inflammatory episodes, potentially leading to secondary amyloidosis. Many studies have assessed the clinical correlation between FMF and Mediterranean fever (MEFV) gene variants (FMF type I). However, few studies have focused on patients who remain relatively asymptomatic and present with renal amyloidosis (FMF type II). We hypothesize that patients with kidney failure carry higher rates of FMF variants. Therefore, our study aimed to assess the rates and types of FMF gene variants in a cohort of patients with kidney failure compared to healthy controls of the same area.</p><p><strong>Methods: </strong>This is a cross-sectional study involving a hemodialysis cohort compared to healthy controls. The controls were healthy university students recruited from the Hashemite University campus. Both groups underwent genetic screening for FMF using polymerase chain reaction and reverse hybridization. Patients with positive genetic screening were offered a colonoscopy with rectal biopsies, which were assessed for the deposition of amyloid proteins.</p><p><strong>Results: </strong>Genetic analysis of the cohort of patients with kidney failure revealed remarkable differences in allele frequency rates across different genotypes. The positivity rate in the hemodialysis cohort reached 16.0%, compared to 12.9% in the healthy controls (p = 0.342, X² = 0.902). Among the different genotypes, V726A and M694V were significantly different between the two groups, with p-values of 0.009 and 0.035, respectively.</p><p><strong>Conclusion: </strong>In our population, patients with kidney failure carried a higher allele frequency of some FMF variants than healthy controls. The M694V and V726A mutations were associated with kidney failure.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968307","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":"Association between primary care physician-nephrologist collaboration and clinical outcomes in patients with stage 5 chronic kidney disease: a JOINT-KD cohort study.","authors":"Minoru Murakami, Takuya Aoki, Yoshifumi Sugiyama, Sho Sasaki, Hiroki Nishiwaki, Masahiko Yazawa, Yoshihiko Raita, Hiroo Kawarazaki, Hideaki Shimizu, Yoshihiro Nakamura, Yosuke Saka, Masato Matsushima","doi":"10.1007/s40620-025-02299-1","DOIUrl":"https://doi.org/10.1007/s40620-025-02299-1","url":null,"abstract":"<p><strong>Background: </strong>Primary care physician-nephrologist collaboration plays an important role in the management of chronic kidney disease (CKD). However, the benefits of such collaboration in patients with stage 5 CKD remain unclear.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult outpatients with stage 5 CKD across nine nephrology centers in Japan. The exposure of interest was primary care physician-nephrologist collaboration. We examined the association between primary care physician-nephrologist collaboration and clinical outcomes in adult outpatients with stage 5 CKD: dialysis initiation and cause-specific hospitalizations using the Fine-Gray models, which treat death and preemptive kidney transplantation and death and kidney replacement therapy as competing risk events, respectively.</p><p><strong>Results: </strong>Of the 570 patients included in the analysis, 91 (16.0%) received primary care physician-nephrologist collaboration, whereas the remaining patients were treated by nephrologists alone. During a median follow-up of 1.4 years, 399 (70.0%) patients started dialysis, 11 (1.9%) received preemptive kidney transplantation, and 53 (9.3%) died. There were no significant between-group differences in dialysis initiation and CKD- and cardiovascular-related hospitalizations (adjusted subdistribution hazard ratio [SHR] [95% confidence interval], 0.89 [0.64-1.23], 1.22 [0.78-1.90], and 0.95 [0.46-1.98], respectively). However, primary care physician-nephrologist collaboration was associated with a lower risk of infection-related hospitalization (adjusted SHR [95% confidence interval], 0.36 [0.15-0.87]).</p><p><strong>Conclusions: </strong>Our findings suggest that primary care physician-nephrologist collaboration in the management of stage 5 CKD is not associated with delayed dialysis initiation but is associated with a lower risk of infection-related hospitalization, indicating the potential benefits of primary care physician-nephrologist collaboration in stage 5 CKD.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025561","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":"Hypercalcemia in a patient with small bowel gastrointestinal stromal tumor: a quiz.","authors":"André Ferreira, Hugo Ferreira, José Maximino Costa","doi":"10.1007/s40620-025-02275-9","DOIUrl":"https://doi.org/10.1007/s40620-025-02275-9","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023483","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":"Migrants on hemodialysis (HD): clinical characteristics, outcome and quality of life.","authors":"Gaetano Alfano, Alberto Albinelli, Camilla Ferri, Roberta Romaniello, Oliviero Giuseppe, Ylenia Cancelli, Giulia Ligabue, Silvia Giovanella, Niccolò Morisi, Francesco Fontana, Riccardo Magistroni, Gabriele Donati","doi":"10.1007/s40620-025-02281-x","DOIUrl":"https://doi.org/10.1007/s40620-025-02281-x","url":null,"abstract":"<p><strong>Background: </strong>Migrants who live on hemodialysis (HD) face unique challenges due to social, linguistic and cultural barriers. This study aimed to describe the demographic and clinical profile of migrants on HD, and compare these findings with the national dialysis population.</p><p><strong>Methods: </strong>A retrospective study was conducted on the HD population at the University Hospital of Modena, Italy. Migrants were defined as adults who entered the country legally or illegally for employment, family reunification and/or to seek asylum.</p><p><strong>Results: </strong>Migrants accounted for 18.2% (55 patients) of the HD population (302 patients) at our center. This group included individuals who came from Africa (61.8%), Europe (20%), Asia (16.4%), and Latin America (1.8%). About one-third (37.5%) arrived in Italy illegally. Most of the migrants (78.1%) were unaware of their kidney condition upon arrival in Italy. Migrants began dialysis at a younger age compared to Italian HD patients (P < 0.001). A higher rate of late referral (P < 0.001) and use of temporary vascular access (P = 0.015) was observed among migrants. No differences were found in the prevalence of hypertension (P = 0.19), diabetes (P = 0.27), and cardiovascular comorbidities (P = 0.055). Only 34.7% of potentially eligible kidney transplant recipients were evaluated for transplantation. Migrants had a significantly higher total EuroQol 5-Dimension 5-Level (EQ-5D-5L) score index (P = 0.046) and reported fewer problems with anxiety/depression (-29.4%; P = 0.03).</p><p><strong>Conclusion: </strong>Migrants started HD at a younger age and had a higher rate of late referral compared to Italian patients. Consequently, dialysis initiation often occurred with temporary vascular access. Despite these issues and limited access to the kidney transplant waiting list, migrants overall reported a better quality of life.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014793","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":"Prediction of intradialytic hypotension by machine learning: A systematic review.","authors":"Jacob Ninan, Nasrin Nikravangolsefid, Hong Hieu Truong, Mariam Charkviani, Larry J Prokop, Raghavan Murugan, Gilles Clermont, Kianoush B Kashani, Juan Pablo Domecq Garces","doi":"10.1007/s40620-025-02288-4","DOIUrl":"https://doi.org/10.1007/s40620-025-02288-4","url":null,"abstract":"<p><strong>Background: </strong>Intradialytic hypotension is associated with increased morbidity, and mortality. Several machine learning (ML) algorithms have been recently developed to predict intradialytic hypotension. We systematically reviewed ML models employed to predict intradialytic hypotension, their performance, methodological integrity, and clinical applicability.</p><p><strong>Methods: </strong>We conducted this systematic review with a pre-established protocol registered at the International Prospective Register of Systematic Reviews (PROSPERO ID: CRD42022362194). Six databases, from their inception to July 20, 2023, were comprehensively searched. Two independent investigators reviewed the articles, extracted data, and evaluated the risk of bias using the Prediction model Risk of Bias Assessment Tool (PROBAST).</p><p><strong>Results: </strong>Out of 84 screened articles, 16 studies with 14,500 adult patients on hemodialysis were included in the review. Fourteen studies (87.5%) were found to have a high risk of bias. The intradialytic hypotension prevalence in the population investigated was between 1.2 and 51%. A diverse range of predictive ML tools were used to predict intradialytic hypotension, with various neural networking models being the most frequent, appearing in 13 studies (AUROC ranges: 0.684-0.978). One study performed both internal and external validation.</p><p><strong>Conclusions: </strong>Researchers have made a concerted effort to develop ML tools to predict intradialytic hypotension. Despite their significant efforts, the lack of thorough external and clinical validation, and heterogeneity among the models and settings have resulted in a substantial challenge to offering ML tools as a global intradialytic hypotension prevention and management solution. Future studies should focus on external and clinical validation of these models to enhance the chances of clinically relevant changes in clinical practices.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996926","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":"Metabolic dysregulation in regulatory T cells from patients with immune-mediated glomerular diseases.","authors":"Johan Noble, Zuzana Macek-Jilkova, Philippe Saas, Paolo Malvezzi, Miguel Fribourg, Leonardo V Riella, Mario Perez Arnedo, Joaquin Manrique, Paolo Cravedi","doi":"10.1007/s40620-025-02306-5","DOIUrl":"https://doi.org/10.1007/s40620-025-02306-5","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007308","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":"Amelioration of uremic toxin indoxyl sulfate by oral chito-oligosaccharide in predialysis patients.","authors":"Chumphon Sirisuksakun, Bancha Satirapoj, Paramat Thimachai, Ouppatham Supasyndh","doi":"10.1007/s40620-025-02279-5","DOIUrl":"https://doi.org/10.1007/s40620-025-02279-5","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976642","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":"Challenges experienced by informal caregivers in contributing to the selfcare practices of haemodialysis patients in Ghana.","authors":"Stephen Kpekura, Yan Shan, Lilian Yiryuo, Gustavus Adolphus Myers-Hansen, Shahinur Parvin","doi":"10.1007/s40620-025-02242-4","DOIUrl":"https://doi.org/10.1007/s40620-025-02242-4","url":null,"abstract":"<p><strong>Background: </strong>In Ghana, the prevalence of chronic kidney disease was 12% in 2017. Global data show that about 70% of people living on kidney replacement therapy are on haemodialysis. Selfcare among haemodialysis patients is important to counteract the multiple difficulties encountered. However, patients on haemodialysis often do not engage enough in selfcare and need the help of \"informal\", usually family caregivers. The purpose of this study was to explore the challenges experienced by caregivers in contributing to the management of haemodialysis patients in Ghana.</p><p><strong>Methods: </strong>Descriptive qualitative research design was employed in this study. The study was conducted at the Tamale Teaching Hospital and the 37 Military Hospital in Ghana. Fourteen caregivers of adult haemodialysis patients who received care at the nephology department of the setting were recruited through purposive sampling, according to the inclusion criteria. The sample size was defined by data saturation. Informal caregivers were interviewed face-to-face using a semi-structured interview, between April and May 2024. Data were analysed manually employing Braun and Clark's six-steps of thematic analysis.</p><p><strong>Results: </strong>Two main themes were identified with seven subthemes, namely, deficit of knowledge on kidney disease and its treatment (poor disease knowledge, poor knowledge on side effects of medications on fistula management, on blood pressure parameters, and on food requirements) and patients' non- adherence (resistance to food and fluid restrictions).</p><p><strong>Conclusion: </strong>Supportive intervention programs may provide both patients and their caregivers with the knowledge and skills required to enable them to contribute effectively to the care of patients undergoing haemodialysis.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998008","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}