Journal of Nephrology最新文献

{"title":"Effects of gliflozins on bone health of patients with chronic kidney disease: a systematic review.","authors":"Mariana Cassani de Oliveira, Lorena Rufino, Ana Laura Mendes Lourenço, Eric Aragão Corrêa, Fabrice Mac-Way, Lauter Eston Pelepenko, Niels Olsen Saraiva Câmara, Rodrigo Bueno de Oliveira","doi":"10.1093/joneph/aajag035","DOIUrl":"10.1093/joneph/aajag035","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are a crucial therapy for chronic kidney disease (CKD), yet concerns persist regarding their impact on bone metabolism. This systematic review evaluates the skeletal safety and metabolic effects of SGLT2i in patients with CKD.</p><p><strong>Methods: </strong>A systematic review of randomized controlled trials (RCTs) and observational cohort studies was conducted. Data on study design, population characteristics, baseline kidney function, bone-related comorbidities, and outcomes (osteoporosis, fractures, falls, amputations, and bone mineral markers) were summarized. Risk of bias was evaluated according to the included category.</p><p><strong>Results: </strong>The analysis revealed that while one RCT and a cohort study reported a significantly increased risk of bone fracture and amputation, this finding was not replicated in other subsequent cohort studies and other RCTs, which generally showed non-significant differences. Of note, the reporting of bone-related outcomes was inconsistent throughout the literature, and a substantial proportion of the evidence derives from studies primarily designed for patients with type 2 diabetes, largely involving early-stage CKD subgroups. One study suggests that SGLT2i may favorably modulate markers of CKD-mineral bone disease (MBD), reporting reduced risk of hyperphosphatemia, hypocalcemia, high parathyroid hormone, and low vitamin D levels. The reviewed literature primarily included data on empagliflozin, canagliflozin, dapagliflozin, and ertugliflozin.</p><p><strong>Conclusions: </strong>Mostly, SGLT2i demonstrated a possible reassuring skeletal safety profile in CKD. Initial safety concerns regarding fractures have not been consistently supported, although evidence in moderate-to-advanced CKD remains limited. Long-term, prospectively defined skeletal outcomes are needed to confirm these findings and clarify class effects.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1116-1128"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148264810","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":"Beyond Waste: Circular Design and the Reimagining of Sustainable Dialysis.","authors":"Katherine A Barraclough","doi":"10.1093/joneph/aajag162","DOIUrl":"10.1093/joneph/aajag162","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1095-1096"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794433","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":"Digital health literacy in patients with chronic kidney disease: a cross-sectional study.","authors":"Melania Totaro, Dania Comparcini, Valentina Simonetti, Francesco Pastore, Marco Fiorentino, Barbara Forastefano, Flavia Minoia, Beatrice Gullo, Maria Elena Flacco, Lamberto Manzoli, Loreto Gesualdo, Giancarlo Cicolini","doi":"10.1093/joneph/aajag118","DOIUrl":"10.1093/joneph/aajag118","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) care is increasingly reliant on digital tools. However, diverse abilities among patients may create a digital divide, exacerbating disparities in health outcomes. Measuring digital health literacy is the first step towards gaining knowledge to develop targeted, patient-centred strategies. Due to a lack of available evidence, this study aimed to assess digital health literacy levels among patients with CKD.</p><p><strong>Methods: </strong>A multicentre cross-sectional study was conducted between July 2024 - January 2025, enrolling CKD patients from three Nephrology Units in central and southern Italy. Data were collected through a questionnaire assessing: (I) sociodemographic data; (II) clinical variables; (III) digital health literacy, using the Health Literacy Population Survey 2019-Digital (HLS19-DIGI) tool; (IV) health information-seeking modalities and behaviours, and digital training.</p><p><strong>Results: </strong>A total of 323 participants were enrolled (mean age 54.8 ± 16.0 years). A 'problematic' level was found with regard to dealing with digital health information, and a 'sufficient' level was observed in interacting with digital health resources. Digital devices were used approximately one to three days per week. Older age and lower level of education were predictors of worse coping and interaction abilities, while these were higher among patients with better socio-economic status, without a caregiver, and who were physically active, and compliant with kidney disease medication and diet. Moreover, on the HLS19-DIGI, retired participants scored lower while digitally trained individuals scored higher. Both seeking information beyond what is provided by health professionals and prior digital training were predictors of more frequent use of digital devices for health.</p><p><strong>Conclusions: </strong>Targeted interventions are warranted to promote digital health literacy and more frequent engagement with digital devices among CKD patients.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1289-1298"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712592","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":"Real-world management of dialysis-requiring acute kidney injury in Italy: a national survey of nephrology centers.","authors":"Erika Naso, Paolo Fabbrini, Marita Marengo, Marco Fiorentino, Giuseppe Castellano, Vincenzo Cantaluppi, Pasquale Esposito","doi":"10.1093/joneph/aajag088","DOIUrl":"10.1093/joneph/aajag088","url":null,"abstract":"<p><strong>Background: </strong>Dialysis-requiring acute kidney injury (AKI-D) is a frequent and severe in-hospital complication associated with high mortality, long-term kidney sequelae, and substantial resource use. National data on AKI-D impact and service organization in Italy are limited.</p><p><strong>Methods: </strong>We conducted a nationwide, web-based, 20-item survey endorsed by the Italian Society of Nephrology. We assessed care settings (dialysis units and other wards, including intensive care units [ICUs]), kidney replacement therapy (KRT) modalities in ICUs, staffing models, monitoring and anticoagulation strategies, and nephrologists' perspectives on barriers and priorities for improvement.</p><p><strong>Results: </strong>Fifty-nine centers responded; analyses focused on 57 adult centers. AKI-D represented ∼20% to >60% of dialysis-unit activity. KRT was frequently delivered outside nephrology wards, most often in cardiac intensive care units (94%) and emergency departments (50.8%). In ICUs, nephrologists primarily prescribed KRT in 73.7% of centers; continuous KRT (CKRT) was available in 94.7%, and regional citrate anticoagulation was first-line in 82.5%. Dialysis dose was reassessed daily in 55.2% of centers. Routine antibiotic therapeutic drug monitoring during CKRT was available in 30.3%, and in 22.8% dedicated post-AKI outpatient clinics. Most indicators were similar between center types; however, structured antibiotic therapeutic drug monitoring during CKRT was more frequently available in University and Hub centers than in Spokes (43.5 vs 31.6 vs 7.1%, respectively, P = .031). Respondents highlighted heterogeneous protocols, limited dedicated staffing, and gaps in multidisciplinary coordination.</p><p><strong>Conclusions: </strong>AKI-D care in Italy is widespread but organizationally heterogeneous across settings, responsibilities, and key operational practices. Standardized pathways, training, and measurable monitoring tools are key priorities for improvement.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1196-1205"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604016","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 video platforms as sources of information on simple renal cysts: a cross-sectional content analysis.","authors":"Feng Tang, Xiqi Dong, Chao Hu, Guoqiang Huang, Jiawei Wang, Hongwei Zhu, Tao Liu, Xiongbing Lu","doi":"10.1093/joneph/aajaf059","DOIUrl":"10.1093/joneph/aajaf059","url":null,"abstract":"<p><strong>Background: </strong>Simple renal cysts are common and usually asymptomatic. Nowadays, short videos on social media have become a major means for obtaining health information. However, there is still insufficient information to evaluate their quality.</p><p><strong>Methods: </strong>In this study, 376 short videos on this topic (ie. simple renal cysts) were selected for a cross-sectional analysis using internationally recognized evaluation tools. The assessment covered content quality, reliability, understandability, and trustworthiness, combined with an analysis of user engagement metrics. The present study was conducted based on data derived from publicly accessible videos on TikTok, Bilibili, Rednote, and Kwai.</p><p><strong>Results: </strong>Videos created by western-medicine specialists showed significantly higher scores for quality and trustworthiness. In contrast, videos made by traditional Chinese medicine practitioners attracted larger audiences but received lower quality ratings. In addition, content with mention of the Bosniak classification tended to be of higher quality, yet with less user interaction.</p><p><strong>Conclusions: </strong>Our study reveals a \"quality-engagement paradox\", in that more accurate and professional content receives less user interaction, while lower-quality videos gain more engagement, thus presenting a challenge for patients to acquire reliable information. Therefore, formulation of platform-specific strategies to improve the visibility and accessibility of trustworthy health content is needed.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1165-1175"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912359","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":"Screening for CKD to halt its growing burden in Europe: a political proposal by the Italian Society of Nephrology.","authors":"Luca De Nicola, Filippo Aucella, Roberto Minutolo","doi":"10.1093/joneph/aajag153","DOIUrl":"10.1093/joneph/aajag153","url":null,"abstract":"<p><p>The year 2025 was crucial for Nephrology: both the World Health Organization (WHO) and the United Nations (UN) formally recognized chronic kidney disease (CKD) as a global health priority among noncommunicable diseases in May and December 2025, respectively. This important milestone is expected to increase worldwide awareness of the urgent need to address the growing burden of CKD. Nephrology is currently undergoing a major paradigm shift: a \"back to the future\" transition from replacing kidney function through dialysis to preserving kidney function through nephroprotective strategies, which reflects the original mission of the specialty. Nowadays, remission of CKD is increasingly achievable; however, low awareness of CKD among both the general population and non-nephrologists remains a key barrier to optimal kidney disease management. Screening for CKD represents the most effective strategy recommended by international health institutions. The Italian Society of Nephrology (SIN) has therefore developed a screening program to be implemented in Italian primary care offices, combined with educational activities focused on CKD identification and management. The proposal is currently under discussion in the Italian Parliament. On April 15th, 2026, representatives of SIN met members of the European Parliament in Brussels during a closed-door meeting aimed at encouraging the European Parliament and Health Commissions to place CKD firmly on the European health agenda and to promote guidance for Member States supporting the development and implementation of national CKD screening programs in the primary care setting.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1151-1157"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794372","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":"Oral Frailty and Health-Related Quality of Life in Maintenance Hemodialysis Patients.","authors":"Hirotaka Saito, Akira Oda, Syuhei Watanabe, Hiroshi Kimura, Jun Asai, Keiji Sato, Hodaka Suzuki, Kaoru Sakurai, Masaaki Eiro, Mamoru Satoh, Michihiro Mitobe, Kenichi Tanaka, Junichiro James Kazama","doi":"10.1093/joneph/aajag257","DOIUrl":"https://doi.org/10.1093/joneph/aajag257","url":null,"abstract":"<p><strong>Background: </strong>Oral frailty may adversely affect health-related quality of life (HRQOL) in patients receiving maintenance hemodialysis, but evidence in dialysis populations remains limited. We examined the association between oral frailty and HRQOL and explored potential indirect pathways through nutritional status, depressive symptoms, and functional status.</p><p><strong>Methods: </strong>This cross-sectional study analyzed baseline data from 350 adults receiving maintenance hemodialysis in the Fukushima Dialysis Cohort Study. Oral frailty was defined as an Oral Frailty Index-8 score ≥4. HRQOL was assessed using the Japanese EQ-5D-5L index. Linear regression models with multiple imputation were used to examine the association between oral frailty and logit-transformed EQ-5D-5L values. Exploratory mediation analyses evaluated the Geriatric Nutritional Risk Index, Patient Health Questionnaire-9, and performance status.</p><p><strong>Results: </strong>Oral frailty was independently associated with lower HRQOL in the fully adjusted model (β = -0.403, 95% confidence interval -0.606 to -0.199; P < 0.001). In single-mediator analyses, indirect effects through depressive symptoms and performance status were significant, whereas the indirect effect through nutritional status was not. In the parallel structural equation model, indirect associations through depressive symptoms and performance status remained significant, while the nutritional pathway was not supported.</p><p><strong>Conclusions: </strong>Oral frailty was independently associated with lower HRQOL in maintenance hemodialysis patients. Exploratory mediation analyses showed significant indirect effects through depressive symptoms and performance status, but not through nutritional status. Oral frailty screening may facilitate timely dental and multidisciplinary care to preserve HRQOL, although prospective evaluation is needed.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127861","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":"Financial toxicity and its associated factors in patients requiring maintenance hemodialysis: a multicenter cross-sectional study in China.","authors":"Juanjuan Li, Dongling Feng, Jing Li, Li Li, Caixia Ma, Yuexia He","doi":"10.1093/joneph/aajag255","DOIUrl":"https://doi.org/10.1093/joneph/aajag255","url":null,"abstract":"<p><strong>Background: </strong>Financial toxicity is a growing concern for patients requiring Maintenance hemodialysis (MHD), affecting their quality of life and treatment adherence. In economically challenged areas like China's Ningxia Province, patients receiving MHD face increased financial burden due to high dialysis costs, transportation, and lost productivity. Identifying the prevalence and associated factors of financial toxicity is crucial for creating interventions to reduce its impact and improve outcomes of patients.</p><p><strong>Methods: </strong>A multicenter cross-sectional study in China involved 1,015 patients receiving MHD from four hospitals. Researchers evaluated financial toxicity, social support, and medical coping using COST-PROM, SSRS, and MCMQ scores. Data analysis was performed with Excel 2016 and SPSS 25.0.</p><p><strong>Results: </strong>The study found a moderate average financial toxicity score of 19.21 ± 4.60. Among participants, 25.5% reported no financial toxicity, 28.4% had mild, and 46.1% experienced moderate financial toxicity. Significant factors related to financial toxicity included monthly household income, medical insurance type, dialysis vintage, number of comorbidities, social support, and coping styles of confrontation and surrender (p < 0.05).</p><p><strong>Conclusions: </strong>Financial toxicity is common among patients receiving MHD in Ningxia, China, linked to factors like low income, resident medical insurance, number of comorbidities, dialysis vintage, limited social support, and specific coping styles. This highlights the need for targeted interventions. Future studies could explore the value of early support for high-risk patients, regular financial toxicity screening, enhanced social networks, and personalized coping strategies might help alleviate this burden.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127909","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":"Obesity in CKD: The Double-Edged Sword.","authors":"Malvinder S Parmar","doi":"10.1093/joneph/aajag256","DOIUrl":"https://doi.org/10.1093/joneph/aajag256","url":null,"abstract":"<p><p>Obesity and chronic kidney disease (CKD) are converging global epidemics with a complex, bidirectional relationship. Obesity directly drives de novo CKD and accelerates its progression via hemodynamic, metabolic, inflammatory, and neuroendocrine pathways culminating in obesity-related glomerulopathy. While advanced and dialysis-dependent CKD exhibit an \"obesity paradox, \" where higher BMI correlates with survival, this is largely driven by reverse causality, survival bias, and BMI's failure to capture true body composition. Emerging metrics like the Body Roundness Index (BRI) demonstrate that central adiposity remains harmful in dialysis populations, with no paradox found in early CKD or kidney transplantation, adding a second, under-recognised dimension to this dual burden. Beyond progression, obesity significantly increases technical risks for core procedures: kidney biopsies, vascular access creation, peritoneal catheter insertion, and kidney transplantation. This review translates these procedural risks into practical optimization strategies, establishes that intentional, structured weight loss in obese CKD individuals is not associated with the excess mortality attributed to unintentional weight loss in CKD. An expanded overview of body composition assessment methods, contemporary and emerging pharmacotherapy including dual incretin agonists, and bariatric and metabolic surgery, including its role and timing relative to kidney transplantation, is presented, alongside a research agenda emphasising precision obesity management and artificial intelligence-assisted risk prediction.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127903","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":"Post-transplant follow-up for kidney transplant recipients: a systematic review of clinical practice guidelines.","authors":"Songjun He, Shiyu Wei, Kexin Zhou, Jingyu Liu, Chuanping Gong, Yufang He, Yujia Zhang, Yan Li","doi":"10.1093/joneph/aajag145","DOIUrl":"https://doi.org/10.1093/joneph/aajag145","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplantation is the treatment of choice for kidney failure, but long-term allograft survival remains challenging. Post-transplant follow-up is essential for monitoring allograft function and managing complications. Although clinical practice guidelines (CPGs) share broad principles, they differ in surveillance timing, frequency, and content. This review compared CPGs for kidney transplant recipients (KTRs), focusing on methodological quality, evidence base, and recommendations.</p><p><strong>Methods: </strong>Journal databases, guideline repositories, and professional association websites were searched for CPGs published between January 2009 and October 2025. Methodological quality was assessed using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Recommendations on follow-up frequency, monitoring content, and implementation were compared.</p><p><strong>Results: </strong>Seven CPGs were included. All recommended intensive early monitoring followed by progressively less frequent surveillance. Differences were most evident in long-term follow-up intervals, protocol kidney allograft biopsy, immunological monitoring, and implementation tools. Most guidelines scored highly in \"Scope and Purpose\" and \"Clarity of Presentation\" but lower in \"Applicability.\" KDIGO had the highest methodological quality, although its earlier publication may limit incorporation of recent evidence and evolving care models.</p><p><strong>Conclusions: </strong>Guidelines agree on general principles but differ in operational recommendations because of variations in resources, healthcare systems, methods, and evidence interpretation. Most follow-up frequency recommendations rely on low-quality evidence or expert consensus. Clinicians should follow local guidance, use international guidance such as KDIGO when local guidance is unavailable, and individualize follow-up according to immunological risk, allograft status, comorbidities, adherence, patient preferences, and resources, while future revisions incorporate emerging evidence from pragmatic studies.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110932","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}