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":"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":"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}

{"title":"Total kidney volume as a predictor of measured glomerular filtration rate in patients with solid tumors: a prospective cross-sectional analysis.","authors":"Regis Otaviano Franca Bezerra, Fernando Louzada Strufaldi, Patricia Perola Dantas, Filipe Andrade, Renato A Caires, Elerson Carlos Costalonga, George Barbério Coura Filho, Luiz A Gil, Marcelo Tatit Sapienza, Giovanni Guido Cerri, Emmanuel A Burdmann, Veronica Torres Costa E Silva","doi":"10.1007/s40620-025-02231-7","DOIUrl":"https://doi.org/10.1007/s40620-025-02231-7","url":null,"abstract":"<p><strong>Background: </strong>Although previous data demonstrate that total kidney volume (TKV) correlates with measured glomerular filtration rate (mGFR), evidence is however scarce in the oncology setting. The aim of this is study is to evaluate whether adding TKV to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimating equations improves the prediction of measured glomerular filtration rate (mGFR) in patients with cancer.</p><p><strong>Methods: </strong>We evaluated patients with solid tumors between April 2015 and September 2017 who had undergone contrast computed tomography and GFR measurement through the plasma clearance of ⁵¹Cr-EDTA. Estimated GFR (eGFR) was determined through CKD-EPI equations based on serum creatinine (eGFRcr) and combined with serum cystatin C (eGFRcr-cys). We used the 2009 eGFRcr and 2012 eGFRcr-cys equations and the race-free 2021 eGFRcr, and eGFRcr-cys. TKV was measured using a semi-automatic segmentation program, excluding non-functional tissues. Linear regression models were built, with TKV and eGFR equations as predictors and mGFR as the outcome.</p><p><strong>Results: </strong>We included 189 patients (median age 58.0 [48.0-65.0] years, 49.2% male). Median mGFR and TKV were 82.7 (66.3-94.5) mL/min and 303.1 (257.7-351.8) cm³, respectively. TKV improved the coefficient of determination (R²) when added to 2009 eGFRcr and 2012 eGFRcr-cys equations from 0.62 to 0.73 and 0.73 to 0.80, respectively. For the 2021 eGFRcr and eGFRcr-cys equations, R² improved from 0.65 to 0.75 and 0.75 to 0.82, respectively.</p><p><strong>Conclusion: </strong>These results suggest that TKV measurement improves the prediction of mGFR in association with the CKD-EPI equations in patients with solid tumors.</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":"144025258","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":"Delayed graft function has comparable associations with early outcomes in primary and repeat transplant among deceased-donor kidney transplant recipients.","authors":"David Stoy, Brenda Muth, Brad C Astor, Didier Mandelbrot, Sandesh Parajuli","doi":"10.1007/s40620-024-02104-5","DOIUrl":"10.1007/s40620-024-02104-5","url":null,"abstract":"<p><strong>Background: </strong>Delayed graft function (DGF) is a common complication and is associated with worse outcomes among kidney transplant recipients (KTRs). There are various risk factors for DGF including previous transplant. We hypothesized that DGF among KTRs undergoing repeat transplant has a greater impact on outcomes compared to primary KTRs.</p><p><strong>Methods: </strong>All deceased-donor KTRs between 01/2000 and 12/2020 at our center were included. Recipients were categorized as primary KTR or repeat KTR (any number of previous kidney transplants). Outcomes of interest included acute rejection, death-censored graft failure, and patient mortality within 12 months post-transplant.</p><p><strong>Results: </strong>A total of 3137 deceased-donor KTRs were included; 2498(80%) were primary KTRs and 639(20%) were repeat KTRs. The rates of DGF were similar between the groups at 29% and 28%, respectively. Compared to KTRs without DGF, DGF was associated with a greater incidence of death and graft failure in both primary and repeat transplants; however, the risk of rejection was not significantly higher in repeat KTRs (p = 0.72). Comparing primary and repeat KTRs, there were no significant differences in either acute rejection (p-interaction = 0.11), death-censored graft failure (p-interaction = 0.38), or death (p-interaction = 0.37). In subgroup analysis among repeat KTRs with DGF, a repeat transplant with no prior DGF was associated with increased risk for death-censored graft failure and death but not for acute rejection. DGF in the prior transplant was protective against death-censored graft failure (HR: 0.07, 95% CI 0.005-0.98, p = 0.05) (p-interaction = 0.04), but this was not significantly associated with acute rejection or death.</p><p><strong>Conclusion: </strong>DGF is associated with similar detrimental outcomes among primary and repeat KTRs.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1183-1190"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372120","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":"Comparison between female kidney donors with prediabetes and without diabetes in blood pressure measurements, kidney and diabetes biomarkers: a prospective cohort study.","authors":"Mahdi Tarabeih, Wasef Na'amnih","doi":"10.1007/s40620-024-02168-3","DOIUrl":"10.1007/s40620-024-02168-3","url":null,"abstract":"<p><strong>Background: </strong>A comprehensive evaluation of potential living kidney donors is crucial to ensure their short and long-term safety. We explored differences in kidney biochemical indicators, blood pressure measurements, and glucose control pre- and post-kidney donation between women with pre-diabetes and those with normal glucose levels.</p><p><strong>Methods: </strong>We performed a prospective cohort study at West Bank and Gaza University hospitals between 2016 and 2022. Differences in sociodemographic and clinical factors that were collected from the participants' medical records between women with pre-diabetes and without diabetes, pre- and post-donation, were assessed using the chi-square test for categorical variables and the Mann-Whitney U test for variables with skewed distribution. Trained nurses performed anthropometric measurements and drew fasting blood samples at various time points from one year before donation to five years after donation.</p><p><strong>Results: </strong>Altogether, 114 female kidney donors (57 with pre-diabetes) aged 27-45 years (median = 35.7, IQR = 5.6) were included in the study. The post-donation median Body Mass Index (BMI) remained higher in women with pre-diabetes (35.02) than in those without diabetes (29.34) five years after donation, (P < 0.001). The 24 h protein, diastolic, and systolic blood pressure levels were significantly higher among women with pre-diabetes than among those without diabetes five years after donation, (P < 0.001). The median estimated glomerular filtration rate (eGFR) was significantly lower in pre-diabetic women (78.2 ml/min/1.73 m²) compared with the non-diabetic participants (87.9 ml/min/1.73 m²) five years after donation, (P < 0.001).</p><p><strong>Conclusions: </strong>Pre-diabetic donors showed an increased risk of adverse outcomes, including hypertension, impaired oral glucose tolerance test, worsening kidney function, and proteinuria. Our findings underscore the importance of maintaining regular check-ups and follow-ups in particular in pre-diabetic kidney donors.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1201-1208"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828429","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}