Journal of Nephrology最新文献

{"title":"Empowering patients to take charge of their kidney health: a healthcare staff perspective in the UK.","authors":"Naeema A Patel, Alice C Smith, Matthew P M Graham-Brown, Laura Willcocks, Courtney J Lightfoot","doi":"10.1093/joneph/aajag112","DOIUrl":"10.1093/joneph/aajag112","url":null,"abstract":"<p><strong>Background: </strong>Self-management is an essential component in the effective management of people living with chronic kidney disease (CKD). While self-management is part of practice guidelines, there is limited understanding of healthcare professionals' views on self-management and how patient self-management is supported and integrated in everyday clinical practice. This qualitative study explored healthcare professionals' perspectives on self-management in CKD, including current clinical practices and the requirements for providing effective self-management support.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with a range of healthcare professionals working in the National Health Service (NHS) in the UK. Topics explored perspectives and experiences of self-management support, lifestyle and education in practice. Interviews were audio recorded, transcribed and analysed using thematic analysis to analyse the data and report themes.</p><p><strong>Results: </strong>Forty-two healthcare professionals were interviewed, and four overarching themes were identified. The themes reflected healthcare professionals' perceptions on CKD self-management, which were: (1) \"the problem with the healthcare landscape in CKD self-management\", (2) need for a personalised approach to CKD management, (3) how to improve self--management support resources, and (4) considerations to improve health equity.</p><p><strong>Conclusions: </strong>The healthcare professionals perceived that the healthcare structure within the NHS does not adequately support self-management, with a notable lack of accessible self-management resources, suggesting a need for evidence-based self-management interventions in CKD that are tailored responsively to individual needs. While these findings arise from the UK context, the issues identified are likely to be relevant and applicable to healthcare systems in other countries.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1266-1277"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764755","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":"Page kidney: imaging clues from a spectrum of etiologies; Lessons for the clinical nephrologist.","authors":"Kavitha B Chittaragi, Shweta Raviraj Poojary, Nayan H B, Harshavardhan Guptha M N","doi":"10.1093/joneph/aajag092","DOIUrl":"10.1093/joneph/aajag092","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1318-1321"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684721","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":"Impact of the management of advanced kidney disease in patients over 80 years of age: a multicenter Spanish study.","authors":"Ignacio Gómez-Rojas, Lucía Criado-Bellido, José García-Casanova, Marina González de Rivera-Utrera, Lucía Rodríguez-Gayo, Irene Martín, Tatiana Niño, Yanieli Hernández-Perdomo, Lina M León-Machado, Diego Barbieri, Carlos Santos-Alonso, José C de la Flor, Laura Espinel, Miguel A Navas, Adriana Puente-García, Miguel Villa-Valdés, Alberto Ortiz, María A Bajo, Borja Quiroga","doi":"10.1093/joneph/aajag108","DOIUrl":"10.1093/joneph/aajag108","url":null,"abstract":"<p><strong>Background: </strong>The decision to initiate kidney replacement therapy (KRT) rather than conservative care in patients with chronic kidney disease (CKD) depends on various factors and carries significant consequences. This study analyzes the impact of choice of treatment modality on hospitalization and survival of very old patients with advanced CKD.</p><p><strong>Methods: </strong>This multicenter, retrospective, observational study analyzed data collected from 11 spanish hospital between 2019 and 2022. The study included patients aged over 80 years with an estimated glomerular filtration rate (eGFR) of less than 15 mL/min/1.73 m2. Baseline epidemiological data and information on comorbidities were collected. The factors associated with the choice of conservative treatment, as well as its impact on hospitalization and survival were analyzed. A sub-analysis was performed comparing patients with a survival time of less than one year.</p><p><strong>Results: </strong>Four hundred ninety-two patients (58.1% male, age 85 ± 4 years) were included. Among them, 262 (53.3%) opted for conservative care, while 230 (46.7%) initiated KRT, of whom 74 (32.1%) did so urgently. Factors independently associated with choosing conservative care were female sex, older age, higher eGFR, and greater level of dependency (all P < .001). During follow-up (21 [13-34] months), 221 patients (44.9%) died. Choosing conservative care was independently associated with mortality (Hazard Ratio [HR] 2.554, P < .001). There was a trend towards an association between urgent initiation of KRT and mortality compared to programmed KRT (HR 2.064, P = .080). In patients surviving less than 12 months, conservative care and KRT exhibited similar outcomes.</p><p><strong>Conclusions: </strong>In very old patients, KRT is associated with better survival than conservative care. However, urgent initiation of KRT or short expected survival reduces the prognostic benefits.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1257-1265"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808804","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":"Profile of a pediatric hypertensive cohort in a tertiary referral center.","authors":"Lotem Weiss, Daniella Magen, Shirley Pollack","doi":"10.1093/joneph/aajag116","DOIUrl":"10.1093/joneph/aajag116","url":null,"abstract":"<p><strong>Background: </strong>The overall prevalence of hypertension (HTN) among Israeli Jewish adolescents was reported to be 0.4% in males and 0.074% in females. The demographic characteristics of the Northern Israeli population are unique, with a nearly equal distribution of Arab and Jewish ethnicity. We describe the demographic and clinical characteristics of pediatric hypertensive patients in northern Israel.</p><p><strong>Methods: </strong>Data were retrospectively collected from the electronic medical records (EMRs) of pediatric patients aged 0-18 diagnosed with HTN at Rambam Health Care Campus between 2010-2020. Demographic characteristics, etiology, end-organ damage, and medical treatment data were collected and compared between specific subgroups.</p><p><strong>Results: </strong>During the study period, 479 children diagnosed with HTN were included. Mean age at diagnosis was 9.6 years. Males made up 64% of the cohort. BMI > 85th percentile was recorded in 45%, and 17% were diagnosed with primary HTN. Primary HTN was more prevalent (32%) in adolescents, the majority of whom were of Jewish ancestry. Obesity prevalence was significantly higher in primary HTN patients. End-organ damage was more common in secondary HTN, subjects of Arab-Muslim origin, consanguinity, and younger age. At follow-up, 35.8% were not on antihypertensive medications. Calcium channel blockers (CCBs) were the most frequently prescribed anti-hypertensives.</p><p><strong>Conclusions: </strong>Higher rates of secondary HTN than reported in the literature were attributed to high consanguinity and resulted in extensive diagnostic procedures across all age groups, unlike what is recommended by the American Academy of Pediatrics (AAP) guidelines. Better adherence to guideline recommendations was demonstrated in patients referred to the pediatric nephrology institute, highlighting the importance of referring HTN patients to specialized clinics.Key words: Hypertension, Adolescents, Obesity.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1278-1288"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148603949","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":"Assessing Patients' ability to learn medication protocols during a hemodialysis session.","authors":"Urooj Khan, Shlomit Rotenberg, Jill I Cameron, Matthew J Oliver, Janine Farragher","doi":"10.1093/joneph/aajag099","DOIUrl":"10.1093/joneph/aajag099","url":null,"abstract":"<p><strong>Background: </strong>People on hemodialysis experience high rates of cognitive impairment and are prescribed complex medication regimens, increasing their risk of medication errors. Although hemodialysis units are convenient settings for medication education, it is unclear whether patients can effectively learn a new regimen during a hemodialysis session.</p><p><strong>Methods: </strong>We conducted a secondary analysis of multicenter, cross-sectional data from Toronto, Canada. One hundred one participants completed the Medication Management Ability Assessment (MMAA), Montreal Cognitive Assessment (MoCA), and Lawton-Brody Instrumental Activities of Daily Living (IADL) scale during the first hour of a hemodialysis session. We calculated the proportion of participants who scored as impaired on the MMAA (≤27), examined predictors of impairment, and calculated correlations between the MMAA, MoCA, and the medication management item from the Lawton-Brody IADL scale.</p><p><strong>Results: </strong>Of 353 patients screened, 101 were eligible and completed all assessments (mean age 67 years; 29% female; median dialysis vintage 36 months). Fifty-five participants (54%; 95% confidence interval [CI]: 44-64%) were impaired on the MMAA, including 23 who reported being independent with medication management in daily life. MMAA scores correlated moderately with the MoCA (r = 0.585, P < 0.001) and were significantly associated with self-reported dependence on the Lawton-Brody medication item (χ2(1, n = 101) = 20.00, P < 0.001). Older age (adjusted odds ratio [OR] = 1.08, 95% CI [1.03, 1.12], P < 0.001) and racialized status (adjusted OR = 3.53, 95% CI [1.23, 10.07], P = 0.019) were significantly associated with impaired MMAA performance in a multivariable logistic regression analysis.</p><p><strong>Conclusion: </strong>Over half of participants had difficulty learning a new medication regimen during a hemodialysis session. Findings highlight the need to reconsider when and how medication education is delivered to this population, and to develop interventions that support their learning.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1230-1237"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712955","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":"Drugs lost in translation in CKD: from redundant designs to learning systems.","authors":"Carmine Zoccali, Francesca Mallamaci, Giovanni Strippoli, Francesco Locatelli","doi":"10.1093/joneph/aajag157","DOIUrl":"10.1093/joneph/aajag157","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) remains a leading cause of morbidity and mortality, yet many promising drugs fail in late-stage development despite plausible biology and strong financial investment. This failure often reflects redundancy in the translational pathway rather than intrinsic lack of efficacy. Preclinical research continues to rely on narrow, reductionist models that poorly recapitulate the chronic, multifactorial nature of human CKD and its cardiovascular complications. Early-phase clinical trials frequently prioritise short-term surrogate endpoints and broad, heterogeneous CKD populations, diluting biologically coherent subgroups and obscuring clinically meaningful effects. Late-phase programmes, exemplified by the recent ocedurenone experience, are then terminated for neutral primary outcomes or safety concerns, with limited transparency and learning from negative data. We argue that CKD drug development must shift towards learning health systems built on human-relevant models, biology-driven enrichment, more appropriate and patient-centred endpoints, and adaptive trial platforms. Systematic reporting and shared analysis of failed and futile trials are essential to avoid repeating avoidable errors. Re-engineering this translational ecosystem is crucial to convert mechanistic insight into durable therapeutic advances for people living with CKD.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1108-1115"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794423","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, primary aldosteronism and renal tubular disorders: a case-based lesson and review of the utility of amiloride.","authors":"Kaitlyn Cinnamond, David Yerushalmy, Stanly Varghese, Liam Casserly","doi":"10.1093/joneph/aajag070","DOIUrl":"10.1093/joneph/aajag070","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1306-1313"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562474","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 neuroimmune architecture of uremic pruritus: mechanisms and therapeutic targeting.","authors":"Lucas Maciel de Almeida Corrêa, Letícia Esteves Dante, Laura de Azevedo Catenaccio, Thifanny Rodrigues de Oliveira, Beatriz Cossini Bonavita Martins, Luiggi Kevin Virgino Brandão, Alexandre de Assis Barbosa, Gabriel Costa de Santana","doi":"10.1093/joneph/aajag135","DOIUrl":"10.1093/joneph/aajag135","url":null,"abstract":"<p><p>Chronic kidney disease-associated pruritus (CKD-aP) remains a prevalent and burdensome symptom whose management is often empirical and only partially effective. Its pathophysiology appears to arise from interacting systemic, cutaneous, neural, and central mechanisms rather than from a single dominant pathway. In this review, we synthesize the evidence for a broader neuroimmune framework encompassing retained uremic solutes, microinflammation, xerosis and barrier dysfunction, immune dysregulation, neuropathic sensitization, opioid imbalance, and neuropeptide signaling. On this basis, we propose a four-node organizing model-Peripheral Neuroimmune Synapse (Node I), Neural Transmission and Hyperexcitability (Node II), Central Opioid Modulation (Node III), and Substance P/NK-1 Amplification (Node IV)-to translate mechanistic complexity into clinically intelligible domains. This model is intended as a pragmatic and hypothesis-generating framework, not as a validated endotyping system. Framed this way, it may help contextualize the observed benefits of therapies such as gabapentinoids and difelikefalin, clarify the limited performance of traditional antihistamine-based strategies, and support a more structured approach to bedside phenotyping and future enrichment-based trials. Prospective validation remains necessary before mechanism-guided therapeutic matching can be recommended as routine clinical practice.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1101-1107"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663530","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":"Feasibility and safety of pegunigalsidase alfa infusion during hemodialysis: first case report in a Fabry patient with kidney failure.","authors":"Eleonora Riccio, Jessica Gambardella, Vincenzo Cuomo, Guido Iaccarino, Antonio Pisani","doi":"10.1093/joneph/aajag159","DOIUrl":"10.1093/joneph/aajag159","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1302-1305"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813429","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":"IMPROVE kidney care: perspectives from marginalised people with CKD and risk factors for CKD on access to, and experience of, kidney care services: a cross-sector collaborative exploration, employing qualitative approaches.","authors":"Rebekah Cheung Judge, Roseline Agyekum, Anjolaoluwa Awe, Muhammad Bojang, Kate Bramham, Stephanie Hanson, Imani Henry Bailey, Lina Johansson, Adam Kamenetzky, Ritika Karamchandani, Jordanna Nunes, Nupur Yogarajah, Shone Surendran, Nadine Fontaine-Palmer","doi":"10.1093/joneph/aajag052","DOIUrl":"10.1093/joneph/aajag052","url":null,"abstract":"<p><strong>Background: </strong>Access to, and experience of, chronic kidney disease (CKD) care is inequitable-with barriers to accessing quality care for marginalised groups. We conducted an exploratory study employing qualitative approaches to understand the factors that influence access to, and experience of, healthcare services for marginalised people with CKD and at risk of CKD.</p><p><strong>Methods: </strong>An exploratory study employing qualitative approaches was conducted as a cross-sector collaboration between kidney care services and an activist, antiracist community-based research and social justice organisation (Mabadiliko Community Interest Company (CIC)). Two groups were recruited: 1) those with risk factors for CKD or early-stage CKD, and 2) people who presented late to kidney care services. Semi-structured interviews were co-designed with people with lived experience and conducted by Mabadiliko CIC. Thematic analysis was undertaken, with themes refined by participants.</p><p><strong>Results: </strong>Twenty interviews were undertaken with a diverse cohort of participants. Knowledge and awareness of CKD was limited, and compounded by a lack of delivery of accessible, culturally congruent information. Significant barriers to accessing kidney care exist for marginalised people, including people who are from global majority ethnic backgrounds, Disabled people, and/or people experiencing material hardship. These barriers are compounded by interpersonal discrimination and paternalistic power dynamics within healthcare interactions.</p><p><strong>Conclusion: </strong>This study captures the experiences of marginalised people at different stages of their journey with CKD, in accessing and engaging with kidney care services. Participants faced a complex array of challenges, highlighting opportunities for multi-level intervention. We outline recommendations to address these issues, co-developed with participants.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1176-1187"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865477","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}