Kidney Research and Clinical Practice最新文献

{"title":"Effectiveness and safety of denosumab on osteoporosis treatment in kidney transplant recipients.","authors":"Jin Kyung Kwon, Yaerim Kim, Jin Hyuk Paek, Kyubok Jin, Seungyeup Han, Woo Yeong Park","doi":"10.23876/j.krcp.24.168","DOIUrl":"10.23876/j.krcp.24.168","url":null,"abstract":"<p><strong>Background: </strong>Denosumab has been reported to improve bone mineral density (BMD), but the clinical impact of denosumab on osteoporosis in kidney transplant recipients (KTRs) remains controversial.</p><p><strong>Methods: </strong>We analyzed 98 KTRs who used denosumab from 2018 to 2023. We investigated the change in BMD, laboratory findings, complications of denosumab, fracture risk assessment tool (FRAX) score, acute rejection within 1 year, and graft failure.</p><p><strong>Results: </strong>Mean T-scores at 1 year after denosumab were significantly increased compared to mean T-scores pre-denosumab at the femur neck and spine area, respectively (-2.68 ± 0.68 vs. -2.81 ± 0.68, p < 0.001; -2.78 ± 0.96 vs. -3.21 ± 1.00, p < 0.001). The levels of calcium and phosphorus significantly decreased and those of vitamin D significantly increased at 1 year after denosumab, but there were no significant differences in parathyroid hormone, allograft function, and tacrolimus trough level. There were no recurrent fractures among 12 KTRs with a history of fracture, but three de novo fractures happened. Cardiovascular events occurred in three patients. Denosumab-induced hypocalcemia developed in eight patients, but severe hypocalcemia was observed in only one patient. Acute kidney injury did not happen. Urinary tract infection (UTI) occurred in 17 patients. Arthralgia occurred in four patients. FRAX score was significantly decreased after denosumab. Acute rejection within 1 year after denosumab developed in three patients. There was no graft failure.</p><p><strong>Conclusion: </strong>The use of denosumab in KTRs is effective and safe for the treatment of osteoporosis and prevention of fracture, but it should be carefully monitored for complications, especially UTI.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":"818-828"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A hidden nonfunctioning kidney in autosomal dominant polycystic kidney disease.","authors":"Yeonsoon Jung, Ye Na Kim, Ho Sik Shin, Hark Rim","doi":"10.23876/j.krcp.26.168","DOIUrl":"10.23876/j.krcp.26.168","url":null,"abstract":"","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":"842-843"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microstructural and functional connectivity changes of decision-related brain networks in end-stage kidney disease patients undergoing peritoneal dialysis.","authors":"Jingjing Yin, Dongxue Luo, Shuhua Ma, Chudan Cai, Xiaoyan Shi, Yanqiang Peng, Jianwei Peng, Lingyu Chen, Yanmin Zheng, Ruiwei Guo, Zelin Zhuang, Zhirong Lin, Lei Xie","doi":"10.23876/j.krcp.24.146","DOIUrl":"10.23876/j.krcp.24.146","url":null,"abstract":"<p><strong>Background: </strong>We aimed to explore changes in decision-related brain microstructure, brain functional activities, and functional connectivity, and their correlations with cognitive function in end-stage kidney disease (ESKD) patients undergoing peritoneal dialysis (PD). Furthermore, the impact of dialysis on these changes was examined.</p><p><strong>Methods: </strong>Thirty ESKD patients undergoing PD, 20 predialysis patients with chronic kidney disease (CKD) stage 5 (predialysis CKD stage 5), and 30 healthy controls (HC) were recruited in this study. Various assessments have been conducted, including neuropsychological scale testing, decision-related behavioral tests, and structural and functional magnetic resonance imaging (MRI) scans.</p><p><strong>Results: </strong>Compared to the HC group, PD and predialysis patients performed poorly in the neuropsychology and Iowa Gambling Task (IGT), PD patients showed decreased functional activation and gray matter volume in multiple decision-related brain areas, including the ventromedial prefrontal cortex (vmPFC), orbitofrontal cortex (OFC), and anterior cingulate cortex (ACC). The default mode network (DMN) and salience network (SAN) were the main brain regions with decreased functional connectivity to vmPFC and ACC. Additionally, compared to the predialysis group, PD patients showed enhanced brain activation in decision-related brain regions such as the ACC, vmPFC, and insula. The structure and function variabilities of the vmPFC were correlated with IGT and Montreal Cognitive Assessment score, and the activation of OFC was negatively associated with blood creatinine, cystatin, and parathyroid hormone levels.</p><p><strong>Conclusion: </strong>In summary, PD can change the structure and function of decision-related brain circuits (vmPFC-OFC-ACC) and reduce integration within DMN and SAN, which is correlated with cognitive function and clinical features. These suggest that PD can improve patients' cognitive function and disease progression to a certain extent.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":"792-806"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances and unmet needs in the management of proliferative lupus nephritis: evidence, guidelines, and emerging therapies.","authors":"Sunhwa Lee","doi":"10.23876/j.krcp.26.089","DOIUrl":"10.23876/j.krcp.26.089","url":null,"abstract":"<p><p>Proliferative lupus nephritis is a major cause of kidney failure and premature mortality in patients with systemic lupus erythematosus. Although mycophenolate-based regimens and cyclophosphamide remain standard induction therapies, up to one-third of patients have refractory disease, and many fail to achieve a complete renal response, as demonstrated in the ASPREVA, AURORA, and BLISSLN trials. Treatment-related toxicity-particularly from prolonged glucocorticoid exposure-contributes to cumulative organ damage. Recent guideline updates emphasize early assessment of treatment response, glucocorticoid minimization, and the selective addition of targeted therapies. Belimumab improves composite and complete renal response rates when added to standard therapy and reduces renal events, particularly in patients with proliferative histology. Voclosporin, a novel calcineurin inhibitor with predictable pharmacokinetics, increases complete renal response rates and rapidly reduces proteinuria in patients with preserved kidney function. Despite these advances, refractory disease and relapse remain common, prompting investigation of additional therapeutic pathways. Obinutuzumab, a type II anti-CD20 monoclonal antibody, demonstrated higher complete renal response rates than placebo in a phase 3 trial, albeit with increased serious infections. Anifrolumab, which targets type I interferon signaling, has shown favorable trends in reducing proteinuria and systemic disease activity in early lupus nephritis studies and is undergoing phase 3 evaluation. Newer agents, such as iscalimab, a CD40 pathway inhibitor, have reduced proteinuria in phase 2 trials. This review summarizes the epidemiology, prognostic markers, and current and emerging therapies, and proposes a practical, response-guided framework aligned with contemporary guidelines to improve kidney outcomes while limiting toxicity.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":"668-676"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148143834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy, safety, and dose selection of efepoetin alfa in anemic patients on maintenance dialysis: a phase 2, randomized, multicenter, active-controlled trial.","authors":"Eun Jeong Ko, Mi-Sun Byun, Chul Woo Yang, Sug Kyun Shin, Hyung Wook Kim, Byung Chul Shin, Seok Joon Shin, Hyeong Cheon Park, Young Sun Kang, Sang-Ho Lee, Ho Cheol Song, Su Hyun Kim, Ki Young Na, Young-Il Jo, Won Kim, Eun Young Seong, Yong-Lim Kim, Hyunjoo Ryu, Heewon Kim, Yoon-Jeong Choi, Byung Ha Chung","doi":"10.23876/j.krcp.26.080","DOIUrl":"10.23876/j.krcp.26.080","url":null,"abstract":"<p><strong>Background: </strong>Efepoetin alfa (GC1113, GX-E2) is a long-acting recombinant human erythropoietin fused to a hybrid fragment crystallizable (hyFc) that prolongs systemic exposure via neonatal Fc receptor-mediated recycling. This active-controlled phase 2 trial evaluated efepoetin alfa and informed phase 3 starting dose selection for chronic kidney disease-related anemia in dialysis patients.</p><p><strong>Methods: </strong>In this multicenter, open-label, active-controlled trial, adults on hemodialysis (HD) or peritoneal dialysis (PD) with hemoglobin (Hb) levels <10 g/dL were randomized after erythropoiesis-stimulating agent discontinuation. Over 12 weeks, HD patients received intravenous efepoetin alfa (5 or 8 µg/kg once weekly [Q1W], 8 µg/kg every 2 weeks [Q2W]) or darbepoetin alfa (30 µg Q1W). PD patients received subcutaneous efepoetin alfa (5 or 8 µg/kg Q2W) or methoxy polyethylene glycol-epoetin beta (0.6 µg/kg Q2W). The primary endpoint was the mean Hb change from baseline after 12 weeks of treatment, and an exploratory dose-conversion ratio (DCR) analysis was performed in the PD cohort to inform phase 3 dosing.</p><p><strong>Results: </strong>Efepoetin alfa showed dose-dependent Hb increases. In the HD cohort, mean Hb increases were 3.19 g/dL for efepoetin alfa 5 and 8 µg/kg Q1W and 2.52 g/dL for darbepoetin alfa. In the PD cohort, mean Hb increases were 2.69 g/dL and 3.48 g/dL for efepoetin alfa 5 and 8 µg/kg Q2W, respectively, and 2.01 g/dL for the control group. Exploratory DCR analysis supported 4 µg/kg Q2W efepoetin alfa as the phase 3 starting dose.</p><p><strong>Conclusion: </strong>Efepoetin alfa demonstrated dose-dependent erythropoietic efficacy and an acceptable safety profile in dialysis patients, supporting dose-range characterization and phase 3 starting dose selection.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":"778-791"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facility-level comorbidity burden and cardiovascular outcome in patients undergoing hemodialysis.","authors":"Hyo Jeong Kim, Seok-Jae Heo, Jung Tak Park, Ga Young Heo, Kyung Won Kim, Yong Uk Kwon, Soo Hyun Kim, Gui Ok Kim, Seung Hyeok Han, Tae-Hyun Yoo, Shin-Wook Kang, Hyung Woo Kim","doi":"10.23876/j.krcp.25.118","DOIUrl":"10.23876/j.krcp.25.118","url":null,"abstract":"<p><strong>Background: </strong>The impact of facility-level comorbidity burden on the prognosis of hemodialysis patients remains unclear. This study aimed to investigate the association between facility-level comorbidity burden and hemodialysis outcomes.</p><p><strong>Methods: </strong>We examined 15,481 participants receiving hemodialysis at primary clinics participating in the Periodic Hemodialysis Quality Assessment by Health Insurance Review and Assessment Service in Korea. Facility-level comorbidity burden, defined as the sum of the Charlson Comorbidity Index of all patients divided by the number of nurses in each hemodialysis center, was the primary predictor. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE).</p><p><strong>Results: </strong>During a median follow-up of 6.8 years, MACCE and all-cause mortality occurred in 9,797 (63.3%) and 8,513 participants (55.0%), respectively. Participants in the highest facility-level comorbidity burden had the highest incidence rates of both MACCE and all-cause mortality. Hazard ratios (HRs) of MACCE and all-cause mortality in the highest vs. the lowest quartile were 1.10 (95% confidence interval [CI], 1.03-1.18) and 1.14 (95% CI, 1.06-1.22), respectively. Applying the facility-level comorbidity burden as a continuous variable, each 10-unit increase in facility-level comorbidity burden was associated with a 4% and 8% higher risk of MACCE and all-cause mortality, respectively. These associations remained consistent across subgroups.</p><p><strong>Conclusion: </strong>Our findings revealed that the facility-level comorbidity burden in hemodialysis centers was associated with a higher hazard of poor outcomes in patients undergoing hemodialysis.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":"45 5","pages":"767-777"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive review of thrombotic microangiopathy: classification, genetics, and management.","authors":"Charan Bale, Vivek Biradar, Atul Sajgure, Tushar Dighe","doi":"10.23876/j.krcp.25.223","DOIUrl":"https://doi.org/10.23876/j.krcp.25.223","url":null,"abstract":"<p><p>Thrombotic microangiopathy (TMA) comprises syndromes characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ injury, most commonly affecting the kidneys and brain. Recent advances have reframed TMAs from classical clinical labels (thrombotic thrombocytopenic purpura [TTP], hemolytic uremic syndrome, secondary TMA) toward a pathway‑based view centered on complement dysregulation, severe ADAMTS13 deficiency, and secondary endothelial injury. This review integrates current data on genetics, environmental \"triggers,\" and clinical presentation to support a two‑hit model in which germline or acquired susceptibility is unmasked by infection, pregnancy, drugs, transplantation, or malignant hypertension. Building on this framework, we propose a stepwise diagnostic approach that combines ADAMTS13 testing, targeted evaluation for secondary causes, and rational use of complement and genetic testing, with the goal of assigning each patient to a dominant pathogenic pathway. Finally, we discuss mechanism‑based treatment strategies-including plasma exchange and immunosuppression for ADAMTS13‑mediated TTP, complement inhibition for complement‑mediated TMA, and trigger‑directed management in secondary forms-and outline key uncertainties regarding treatment duration, relapse prediction, and access to advanced therapies.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and external validation of an explainable machine learning model for predicting chronic kidney disease progression in the Korean population.","authors":"Hojun Yu, Yon Su Kim, Kwon Wook Joo, Kook-Hwan Oh, Dong Ki Kim, Hajeong Lee, Seung Seok Han, Eunjeong Kang, Sehoon Park, Byoungjun Jeon, Yong Chul Kim","doi":"10.23876/j.krcp.26.055","DOIUrl":"10.23876/j.krcp.26.055","url":null,"abstract":"<p><strong>Background: </strong>Current risk stratification models, such as the Kidney Failure Risk Equation (KFRE), exhibit variable performance across ethnic groups and fail to capture dynamic clinical trajectories. This study aimed to develop and validate a Korean-specific machine learning (ML) model for predicting chronic kidney disease (CKD) progression using an ensemble approach.</p><p><strong>Methods: </strong>We used electronic health records from Seoul National University Hospital for model development (n = 28,209) and the Korean Genome and Epidemiology Study (KoGES) CKD cohort for external validation (n = 3,960). The primary outcome was a composite of ≥40% decline in estimated glomerular filtration rate (eGFR) or progression to end-stage renal disease within 2 years. A soft-voting ensemble of four ML algorithms (XGBoost, LightGBM, CatBoost, and Random Forest) was developed.</p><p><strong>Results: </strong>The ensemble model demonstrated robust discrimination in internal validation (area under the receiver operating characteristic curve [AUROC], 0.939; 95% confidence interval [CI], 0.934-0.944), significantly exceeding the KFRE (AUROC, 0.879-0.884). External validation in the KoGES cohort showed comparable discrimination (AUROC, 0.859; 95% CI, 0.798-0.914) versus KFRE (four-variable AUROC, 0.882; 95% CI, 0.818-0.935). Shapley Additive exPlanations (SHAP) analysis identified baseline eGFR, serum creatinine, eGFR slope, albumin, and hemoglobin as key prognostic features, supporting a complementary framework using KFRE for community screening and the ML model for hospital-based risk stratification.</p><p><strong>Conclusion: </strong>The ensemble ML model accurately predicts short-term CKD progression in Korean patients. By incorporating longitudinal features and ensemble learning, it provides a precise alternative to Western-derived equations, particularly in tertiary care settings.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":"724-742"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148258702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Denosumab for kidney transplant recipients: clinical value and unresolved questions.","authors":"Hye-Sun Park","doi":"10.23876/j.krcp.25.138","DOIUrl":"10.23876/j.krcp.25.138","url":null,"abstract":"","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":"45 5","pages":"650-652"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise as an adjunctive therapy for patients on maintenance hemodiafiltration.","authors":"Jessica L F Andrade, Ayden T Heitmann, Miguel K Rodrigues, Dave K Marchand, Adelson M Rodrigues, Bruno P Biluca, Rene Freitas, Thiago Reis, Miguel A Goes, Mayron F Oliveira","doi":"10.23876/j.krcp.24.243","DOIUrl":"10.23876/j.krcp.24.243","url":null,"abstract":"<p><strong>Background: </strong>Fatigue and sedentarism are common in kidney disease and dialysis treatment. Although hemodiafiltration effectively removes solutes and improves mortality, the influence of exercise as an adjunct therapy on maintenance hemodiafiltration programs remains understudied.</p><p><strong>Methods: </strong>A multicenter 6-month study was assessed comparing individuals with chronic kidney disease enrolled in exercise training (exercise group) during dialysis (intradialytic vs. interdialytic) compared to usual care (control group). Physical tests included a YMCA step test for endurance, handgrip, and one-repetition maximum for muscle strength. Single-pool, standard, and equilibrated Kt/Vurea were surrogates for hemodiafiltration adequacy.</p><p><strong>Results: </strong>Eighty-nine patients (aged 54 ± 15 years) and 33 control patients (aged 60 ± 17 years) underwent the exercise protocol. The mean disease vintage was 108 ± 84 and 132 ± 108 months, respectively, while the dialysis vintage was 60 ± 42 and 60 ± 36 months. Control-group Kt/Vurea showed improvement from baseline to month 6 (single-pool, 1.18 ± 0.03 to 1.30 ± 0.04; standard, 1.94 ± 0.04 to 2.09 ± 0.04; equilibrated, 1.09 ± 0.03 to 1.21 ± 0.02; p < 0.001). However, exercise-group Kt/Vurea showed a comparatively greater improvement between the baseline and month 6 (single pool, 1.19 ± 0.05 to 1.47 ± 0.04; standard, 1.99 ± 0.03 to 2.15 ± 0.03; equilibrated, 1.08 ± 0.03 to 1.24 ± 0.03; p < 0.001). The exercise group had a statistically significant increase in the handgrip test (279.5 ± 78.5 N to 295.2 ± 76.5 N, p < 0.01) and fat-free mass (13.9 ± 2.8 kg/m2 to 14.4 ± 2.7 kg/m2, p < 0.01). There were no statistically significant differences between the interdialytic and intradialytic groups in dialysis adequacy and exercise variables.</p><p><strong>Conclusion: </strong>Supervised exercise for maintenance hemodiafiltration patients was associated with improvements in dialysis efficiency/ performance outcomes. The results support exercise as an adjunct therapy for hemodiafiltration patients whether conducted during the intradialytic or interdialytic period.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":"754-766"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}