Journal of Nephrology最新文献

{"title":"A preventable problem in pregnancy.","authors":"Kareem Elbosaty, Alaa Sabry, Giorgina B Piccoli, Rasha Shemies","doi":"10.1007/s40620-025-02274-w","DOIUrl":"https://doi.org/10.1007/s40620-025-02274-w","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021461","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":"Outpatient clinic for older patients with chronic kidney disease: a model of a multidisciplinary care model.","authors":"Mariana Leister Rocha Innecchi, Carla Maria Avesani, Venceslau A Coelho, Julia Castanheira Lauar, Tiago Emanuel Mendes Costa, Luiza Karla Ramos Pereira de Araújo, Rosa M A Moysés, Rosilene M Elias","doi":"10.1007/s40620-025-02293-7","DOIUrl":"https://doi.org/10.1007/s40620-025-02293-7","url":null,"abstract":"<p><strong>Background: </strong>The number of older patients with chronic kidney disease (CKD) is increasing worldwide. Managing clinical conditions in this population is challenging due to multimorbidity, including frailty, malnutrition, sarcopenia, and functional status impairment. This clinical scenario, in association with the decrease in kidney function, requires specific care.</p><p><strong>Methods: </strong>We propose a new care model for older patients with moderate/advanced CKD involving a multidisciplinary and interdisciplinary team. This team includes nephrologists, geriatric physicians, nurses, and dietitians. To achieve the best results, patients' clinical, laboratory and geriatric conditions are routinely assessed to support better shared decision-making.</p><p><strong>Results: </strong>Since this model was created (July 2017), 607 patients > 60 years old, most of whom had CKD stages 3b to 5, have been seen at least once. Of these, 439 (72.3%) patients have been followed for a median of 19.6 (9.3, 37.1) months, with an average follow-up interval of 4.4 months. At their first visit, most patients were overweight, 68.7% were independent with regard to activities of daily living, and 21.4% had severely impaired functional capacity. Cognitive impairment was found in 40.5% of patients. In 70.1% of the patients, the median decrease in estimated glomerular filtration rate (eGFR) was 1.4 ml/year over time. The change in eGFR did not correlate with age (r = 0.011, p = 0.839). Among patients with CKD stage 4 or 5, 15% decided to not start dialysis based on a shared-decision making process.</p><p><strong>Conclusion: </strong>The proposed multidisciplinary care model for older patients with CKD guides the multiprofessional identification of various conditions that might otherwise go unnoticed, while emphasizing the importance of each healthcare professional. This approach might increase the likelihood of adopting a more holistic view of patients, ultimately leading to better shared decision-making.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987756","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":"The hidden emotional costs of giving life: preserving donors' mental health and quality of life after living kidney donation.","authors":"Xavier Torres, David Paredes-Zapata, Ignacio Revuelta","doi":"10.1007/s40620-025-02291-9","DOIUrl":"https://doi.org/10.1007/s40620-025-02291-9","url":null,"abstract":"<p><p>Kidney living donation remains the best treatment available for kidney failure. Most living donors report positive personal outcomes, such as enhanced life satisfaction and personal growth. However, mental health challenges have also been documented. The study by Tahir, Aftab and Nabi (J Nephrol https://doi.org/10.1007/s40620-025-02217-5 , 2025) call the attention to a small subset of living donors who may experience significant depression symptoms and occasionally suicidal ideation after donation, particularly when the recipient dies or suffers severe graft failure with a return to dialysis. As observed in the previous studies, only donors whose recipients experienced negative outcomes reported mood alterations or life dissatisfaction (Menjivar et al., Transpl Int 31(12):1332-1344, 2018). These rare post-donation risk scenarios justify a careful mental evaluation to identify psychological vulnerabilities or a history of difficulties in managing and coping with stressful situations. These adverse outcomes appear more likely in donors with pre-donation physical and/or psychological vulnerabilities, in those with a complicated surgical recovery after donation, and in cases where recipients experience poor physical or psychological outcomes. Moreover, cases of graft failure or recipient death might significantly increase donor's likelihood of depression and anxiety, Despite the generally low incidence of psychosocial problems after donation, there have been calls for a more structured and routine follow-up assessment to further mitigate risks and ensure equitable mental health safety for all kidney donors.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030118","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":"Phenotype-genotype correlations in patients with Alport syndrome from the Polish population.","authors":"Maria Malarska, Hanna Moczulska, Paulina Pachniak, Karolina Gadzalska, Paulina Jakiel, Monika Gorządek, Ewa Juścińska, Michał Pietrusiński, Marcin Mazerant, Agnieszka Pukajło-Marczyk, Katarzyna Kiliś-Pstrusińska, Alicja Majos, Michał Podgórski, Agnieszka Zmysłowska","doi":"10.1007/s40620-025-02251-3","DOIUrl":"https://doi.org/10.1007/s40620-025-02251-3","url":null,"abstract":"<p><strong>Background: </strong>Alport syndrome (AS) is a rare inherited kidney disease associated with progressive renal failure and visual and hearing disorders. The purpose of this study was to find genetic variants in patients with suspected Alport syndrome from Central and Southwestern Poland and their association with the clinical course of the disease, and to evaluate the impact of Alport syndrome on pregnancy.</p><p><strong>Methods: </strong>Initially, 90 patients with suspected Alport syndrome were evaluated by molecular-based testing. Clinical analyses, including urinalysis, evaluation of serum parameters, ultrasound, ophthalmologic, cardiovascular and audiology examination, and genetic testing were performed using next-generation sequencing and the Sanger method.</p><p><strong>Results: </strong>Seventy-seven patients (40.26% male; 59.74% female) with a median age of 6 years were included in the study group, after receiving a diagnosis of Alport syndrome. Twenty pathogenic/potentially pathogenic variants within the COL4A3, COL4A4 and COL4A5 genes were identified in these patients. The c.1871G > A variant in the COL4A5 gene was the most common (53.25%). Isolated hematuria was the most common initial sign of Alport syndrome (70.8%). Genetic testing confirmed Alport syndrome in 85% of symptomatic patients and in 15% of asymptomatic patients. Sensorineural hearing loss (17%) and ocular abnormalities (6%) were also detected in patients in the study group. Isolated hematuria showed a significant association with COL4A5 gene variants (p < 0.001). Genetic variants showed an association with initial clinical symptoms and age at Alport syndrome manifestation.</p><p><strong>Conclusions: </strong>Regular urinalysis and genetic testing should be considered in suspected cases of Alport syndrome for rapid diagnosis and effective patient management.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012454","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":"Kidney failure care for migrants: a European survey.","authors":"Cédric Rafat, Ewa Pawlowicz-Szlarska, Gaetano Alfano, Alice Doreille, Amaryllis H Van Craenenbroeck, Liz Lightstone, Valérie Luyckx, Silvia Salaro, Maria Jose Soler, Dominique Tudor, Andreas Kronbichler, Safak Mirioglu","doi":"10.1007/s40620-025-02290-w","DOIUrl":"https://doi.org/10.1007/s40620-025-02290-w","url":null,"abstract":"<p><strong>Background: </strong>The management of migrants with kidney failure and no medical insurance raises complex medical, social, financial, and ethical issues. The survey aimed to investigate (i) current practices in managing these patients, and (ii) the perspective of European nephrologists on ethical dilemmas and optimal care.</p><p><strong>Methods: </strong>The survey was piloted by the ISN Western Europe Regional Board, with members of the Young Nephrologists' Platform (YNP) of the European Renal Association (ERA), and disseminated to European nephrologists in the ISN and YNP networks. Responses were collected anonymously via SurveyMonkey.</p><p><strong>Results: </strong>A total of 378 responses were collected from 29 European countries. Most (57%) managed fewer than 3 migrant patients with kidney failure per week, while 10% managed more than 11. Most respondents indicated that access to dialysis was unrestricted (59%), although only 25% said migrant patients were systematically eligible for kidney transplantation. Many nephrologists (38%) were unaware of the directives of governmental bodies or hospital protocols regarding migrant patients. The most common obstacles to patient management included language non concordance (64%), uncertainty about the future (56%), and lack of knowledge of medical history (49%). Two-thirds felt managing migrant patients was a moral duty, though 52% reported stress within the clinical caregiving team.</p><p><strong>Conclusion: </strong>Despite strong commitment from European nephrologists, a fragmented legal framework, remaining barriers, and uneven case distribution hinder optimal care for migrant patients with kidney disease.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968278","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":"Development and validation of the thirst distress scale for patients with autosomal dominant polycystic kidney disease.","authors":"Seyda Gul Ozcan, Sibel Gokcay Bek, Necmi Eren, Zeynep Atlı, Abdülmecit Yıldız, İsmail Koçyiğit, Caner Çavdar, Nana Waldréus, Tevfik Ecder, Nurhan Seyahi","doi":"10.1007/s40620-025-02287-5","DOIUrl":"https://doi.org/10.1007/s40620-025-02287-5","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015860","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":"Proenkephalin (PENK): a functional biomarker in chronic kidney diseases - hope or just a new bystander?","authors":"Wiktoria Grycuk, Zuzanna Jakubowska, Jolanta Małyszko","doi":"10.1007/s40620-025-02268-8","DOIUrl":"https://doi.org/10.1007/s40620-025-02268-8","url":null,"abstract":"<p><p>Proenkephalin has recently emerged as a promising biomarker of kidney function which improves the early detection of acute kidney injury (AKI) compared to creatinine-based methods. Plasma Proenkephalin concentrations have shown a correlation with glomerular filtration rate (GFR) as assessed by gold standard methods. Previous studies have demonstrated its association with adverse clinical outcomes in various settings, including sepsis, heart failure, kidney transplantation, and chronic kidney disease (CKD). Additionally, in healthy individuals, elevated Proenkephalin concentrations have been linked to a decline in GFR and an increased risk of developing CKD. While evidence suggests that Proenkephalin may be a more accurate tool for assessing glomerular filtration and detecting AKI, recent research has primarily focused on subjects with preserved kidney function, leaving its value in CKD patients less explored. Given the heterogeneity and high risk of rapid renal deterioration in patients with chronically impaired kidney function, a reliable biomarker should retain its ability to reflect kidney function in both CKD and AKI settings. This review summarizes the current evidence on Proenkephalin in patients with chronic kidney diseases.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997507","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":"Short-term prognostic score for very elderly patients, aged 85 or older, initiating hemodialysis.","authors":"Daisuke Mori, Masato Hayashi, Ryoko Honda, Haruna Tanoue, Midori Kobayashi, Motoko Shimada, Shinjiro Tamai, Hiroki Nomi, Katsuyuki Nagatoya, Atsushi Yamauchi","doi":"10.1007/s40620-025-02292-8","DOIUrl":"https://doi.org/10.1007/s40620-025-02292-8","url":null,"abstract":"<p><strong>Background: </strong>As the population ages, factors affecting prognosis after dialysis initiation in very elderly patients remain unclear. We aimed to develop a prognostic score to predict short-term survival in this group.</p><p><strong>Methods: </strong>This retrospective cohort study included 116 patients aged 85 or older who initiated hemodialysis at our hospital between 2010 and 2023, out of a total of 2279 patients. Using a Cox regression model, we analyzed factors affecting 3-year all-cause mortality. Based on these analyses, a prognostic scoring system was developed to predict patient outcomes.</p><p><strong>Results: </strong>Baseline factors independently associated with mortality (hazard ratio (HR), 95% confidence interval (CI)) included body mass index (BMI) < 18.5 (2.14, 1.17-3.91), cardiovascular disease (2.16, 1.10-4.22), advanced cancer (4.65, 1.73-12.5), impaired walking (2.33, 1.17-4.64), emergency dialysis without fistula (1.88, 1.03-3.44), fluid overload (2.70, 1.43-5.07), serum albumin < 3.0 g/dL (2.32, 1.25-4.32), and C reactive protein (CRP) > 0.5 mg/dL (3.87, 1.85-8.10). A scoring system was developed, assigning 1 point each for BMI < 18.5, cardiovascular disease, impaired ambulation, emergency dialysis without fistula, fluid overload, and serum albumin < 3.0 g/dL, and 2 points for advanced cancer and CRP > 0.5 mg/dL. The score demonstrated an area under the ROC curve of 0.83. The hazard ratios for 3-year mortality for scores of 4-5 and 6 or higher, compared to 0-3, were 2.55 (95% CI: 1.04-6.23) and 7.10 (3.36-15.0), respectively (P for trend < 0.001). Subgroup analyses confirmed the score's robustness.</p><p><strong>Conclusion: </strong>The prognostic score for 3-year mortality in very elderly patients who initiate dialysis should be validated in different populations and is expected to inform decisions regarding dialysis initiation.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969988","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":"The systemic and kidney hemodynamic response to empagliflozin, losartan and their combination varies between individuals.","authors":"Britt Eveline Wever, Rosalie Annemien Scholtes, Charlotte Michelle Mosterd, Anne Clasien Hesp, Mark Martinus Smits, Hiddo Jan Lambers Heerspink, Daniël Henri van Raalte","doi":"10.1007/s40620-025-02289-3","DOIUrl":"https://doi.org/10.1007/s40620-025-02289-3","url":null,"abstract":"<p><strong>Background: </strong>Renin-angiotensin system inhibitors (RASi) and sodium glucose cotransporter inhibitors (SGLT2i) are known for their kidney protective properties, but both show significant residual risk in large outcome trials. In these trials, SGLT2i were introduced on top of RASi; the individual response to each drug is currently unclear. We therefore aimed to investigate the individual reactions to the angiotensin II receptor blocker (ARB) losartan and the SGLT2i empagliflozin and their combination on measured GFR (mGFR) and systolic blood pressure (SBP).</p><p><strong>Methods: </strong>In this double-blind, randomized, 4-armed, crossover study, 24 participants received 7 days of empagliflozin 10 mg once daily, losartan 50 mg once daily, combination therapy or matching placebo. We visualized individual drug response variability. We further explored predictors of mGFR and SBP changes.</p><p><strong>Results: </strong>During empagliflozin administration, a greater than 10% reduction in mGFR was observed in 26% of participants receiving empagliflozin, in 30% of those receiving losartan, and in 39% among participants on combination therapy. In comparison, a greater than 10% reduction in SBP was observed in 35% of participants on empagliflozin, in 39% of those receiving losartan and in 43% on combination therapy. A large part of the participants who did not respond to one drug, did respond to the other drug or their combination. Monotherapy SGLT2i did not correlate with monotherapy ARB in mGFR change or SBP change.</p><p><strong>Conclusions: </strong>Our data show large individual variability in response to treatment with the ARB losartan and the SGLT2i empagliflozin. Clinicians should monitor treatment responses in patients and consider switching from one kidney protective drug to another in non-responders.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007311","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":"Pregnancy on short daily home hemodialysis using low flow dialysate. A narrative review of the literature and a new case report.","authors":"Anne-Lorraine Clause, Philippe Dethier, Giorgina Barbara Piccoli, Giuseppe Gambino","doi":"10.1007/s40620-025-02265-x","DOIUrl":"https://doi.org/10.1007/s40620-025-02265-x","url":null,"abstract":"<p><p>Pregnancy in dialysis patients remains a rare occurrence due to low fertility rates. Furthermore, pregnant women with kidney failure are exposed to a range of fetal-maternal hazards, potentially resulting in severe hypertension, polyhydramnios, intrauterine growth restriction, preterm birth, and stillbirth. However, the incidence of pregnancies in women living with kidney failure has increased over the last decades, and both intensification of dialysis schedule and advances in neonatal care have led to improvement in pregnancy outcomes. Although guidelines for treating pregnant women with kidney failure advocate for intensification of both dialysis frequency and duration, the best and most feasible schedule has not yet been established. Successful pregnancy on daily home hemodialysis using low dialysate flow rate (200 mL/min) by means of small dialysis machines and prepacked dialysate bags (Nx Stage, Physidia S3 systems) was first reported in 2016. We aimed to review the available literature on low dialysate flow rate hemodialysis during pregnancy and report on our experience with a successful pregnancy in a woman who decided to continue home hemodialysis by means of low dialysate flow rate hemodialysis. The literature and our case report underline the importance of considering the patient's modality preferences, and residual kidney function, in the absence of consensus regarding a dialysis intensification strategy.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005404","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}