Kidney International Reports最新文献

{"title":"IMPACT CKD – All Roads Must not Lead to Dialysis","authors":"Barnaby Hole , Fergus J. Caskey , Lucy E. Selman","doi":"10.1016/j.ekir.2025.04.063","DOIUrl":"10.1016/j.ekir.2025.04.063","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 8","pages":"Page 2886"},"PeriodicalIF":5.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of 2 Icodextrin Exchanges per Day in Incident Peritoneal Dialysis Patients: Are There Incremental Benefits?","authors":"Sharon J. Nessim","doi":"10.1016/j.ekir.2025.06.013","DOIUrl":"10.1016/j.ekir.2025.06.013","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 8","pages":"Pages 2533-2534"},"PeriodicalIF":5.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole Exome Sequencing in Chinese Pediatric Patients With Nephrolithiasis","authors":"Xiaochuan Wang ,&nbsp;Yining Zhao ,&nbsp;Youquan Zhao ,&nbsp;Minglei Li ,&nbsp;Fangzhou Zhao ,&nbsp;Boyu Yang ,&nbsp;Hui Quan ,&nbsp;Sujuan Zhao ,&nbsp;Ye Tian ,&nbsp;Hongquan Geng ,&nbsp;Jun Li","doi":"10.1016/j.ekir.2025.04.056","DOIUrl":"10.1016/j.ekir.2025.04.056","url":null,"abstract":"<div><h3>Introduction</h3><div>The incidence of pediatric nephrolithiasis has been increasing, and the role of genetic factors has garnered attention in recent years. This study aimed to explore the genetic basis underlying pediatric nephrolithiasis in Chinese population.</div></div><div><h3>Methods</h3><div>Whole exome sequencing (WES) was conducted in a consecutive cohort of 456 children over a 11-year period. Clinical and genetic data were systematically collected, analyzed, and comprehensively compared.</div></div><div><h3>Results</h3><div>Average age was 4.2 years with a male-to-female ratio of 2.2. A total of 260 causative variants in 16 genes were identified in 141 children, resulting in a positive molecular diagnosis rate of 31%. Of the causative variants, 43% were novel. The most prevalent diagnoses were primary hyperoxaluria (PH) (<em>AGXT</em>: 20%, <em>GRHPR</em>: 11%, and <em>HOGA1</em>: 24%) and cystinuria (<em>SLC3A1</em>: 18% and <em>SLC7A9</em>: 14%). Children with positive molecular diagnoses were more likely to have stone episodes, bilateral stones, multiple stones, or nephrocalcinosis (all <em>P</em> &lt; 0.05). Children with <em>AGXT</em> defects were more prone to have severe clinical manifestations, and those with <em>HOGA1</em> defects and males with <em>SLC3A1</em> and <em>SLC7A9</em> defects tended to be diagnosed at a younger age. The concordance rate between suspected clinical diagnoses and molecular diagnoses was 81%. At least 29% of children could benefit from additional clinical advice based on a molecular diagnosis.</div></div><div><h3>Conclusion</h3><div>A genetic etiology was identified in 141 of 456 of pediatric patients (31%) with nephrolithiasis in a Chinese cohort. A positive molecular diagnosis is a risk factor for severe clinical presentation of pediatric nephrolithiasis. WES has the potential to be used to confirm or even modify clinical diagnoses, thereby facilitating individualized therapeutic and preventive interventions.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 8","pages":"Pages 2789-2799"},"PeriodicalIF":5.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Syndecan-1 is Associated With Kidney and Cardiovascular Outcomes in Idiopathic Nephrotic Syndrome","authors":"Colin Bauer ,&nbsp;Arshia Anand ,&nbsp;Christine Sethna ,&nbsp;Jonathan Troost ,&nbsp;Tarak Srivastava ,&nbsp;Imtiazul Islam ,&nbsp;Audrey Fetsko ,&nbsp;Julie A. Dougherty ,&nbsp;William E. Smoyer ,&nbsp;Richard J. Johnson ,&nbsp;Gabriel Cara-Fuentes","doi":"10.1016/j.ekir.2025.04.055","DOIUrl":"10.1016/j.ekir.2025.04.055","url":null,"abstract":"<div><h3>Introduction</h3><div>Idiopathic nephrotic syndrome (INS) is associated with important kidney and cardiovascular morbidities. We tested the hypothesis that serum syndecan-1, a marker of endothelial glycocalyx injury, can help identify patients at risk for unfavorable kidney and cardiovascular outcomes.</div></div><div><h3>Methods</h3><div>We included 348 children and adults with INS (<em>n</em> = 35 unbiopsied, <em>n</em> = 141 minimal change disease [MCD] and <em>n</em> = 172 focal segmental glomerulosclerosis [FSGS]) from the Nephrotic Syndrome Study Network (NEPTUNE) cohort and 34 healthy participants (<em>n</em> = 22 adults, <em>n</em> = 12 children). We measured baseline serum syndecan-1 levels using an enzyme-linked immunosorbent assay and evaluated their relationship with kidney and cardiovascular outcomes. We performed <em>in vitro</em> studies to test whether INS sera and different therapeutics may alter syndecan-1 expression in human glomerular endothelial cells (GEnC).</div></div><div><h3>Results</h3><div>Serum syndecan-1 was higher in patients with INS than in controls and was high in approximately one-third of patients without proteinuria or with subnephrotic proteinuria. Patients receiving steroids, regardless of disease activity, showed higher syndecan-1 than those off immunosuppression. Syndecan-1 was higher in proteinuric patients with MCD than in FSGS. At the time of serum collection, syndecan-1 modestly correlated with proteinuria but not with kidney function. In longitudinal analyses, serum syndecan-1 was associated with the composite of 40% decline in kidney function or kidney failure and with dyslipidemia. Compared with controls, INS sera in relapse increased syndecan-1 expression in cultured GEnC, and this was partially or fully mitigated when dexamethasone or a metalloprotease inhibitor were added, respectively, to culture media.</div></div><div><h3>Conclusion</h3><div>Baseline serum syndecan-1 is associated with unfavorable kidney outcomes and cardiovascular risk factors in INS.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 8","pages":"Pages 2732-2740"},"PeriodicalIF":5.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Progress of Nephrology in Pacific Island Countries of Oceania","authors":"Yogeshni Chandra ,&nbsp;Anis Ta’eed ,&nbsp;Ben Matalavea ,&nbsp;David Voss ,&nbsp;Mignon McCulloch ,&nbsp;Brett Cullis ,&nbsp;Shilpanjali Jesudason ,&nbsp;Angus Ritchie","doi":"10.1016/j.ekir.2025.06.032","DOIUrl":"10.1016/j.ekir.2025.06.032","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 8","pages":"Pages 2511-2514"},"PeriodicalIF":5.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CARI Guideline: Evidence-Based Recommendations for Balanced Electrolyte Solutions to Improve Kidney Transplant Outcomes","authors":"Colm O’Reilly ,&nbsp;David Tunnicliffe ,&nbsp;Allan Blackley ,&nbsp;Michael Collins ,&nbsp;Emmy O’Neill ,&nbsp;Siah Kim ,&nbsp;Karthik Venkataraman ,&nbsp;Emily See ,&nbsp;Ross Francis","doi":"10.1016/j.ekir.2025.05.051","DOIUrl":"10.1016/j.ekir.2025.05.051","url":null,"abstract":"<div><div>Kidney transplantation is an optimal treatment for kidney failure; however, delayed graft function is a common complication with a prevalence of up to 40% in deceased donor transplantation. The use of i.v. fluids during kidney transplantation is required for hemodynamic stability; however, there are concerns that normal saline may contribute to increased delayed graft function and hyperchloremic metabolic acidosis. Balanced electrolyte solutions have been suggested as an alternative i.v. fluid that may decrease delayed graft function. However, there have been concerns that this may increase hyperkalemia in transplant recipients. This guideline seeks to synthesize the available evidence and make recommendations for the Australian and New Zealand care by a multidisciplinary working group, including consumers with lived experience of kidney transplantation.</div><div>A recently published systematic review and meta-analysis of randomized controlled trials (RCTs), including data from the BEST Fluids trial, evaluating balanced electrolyte solutions versus normal saline in kidney transplants was identified and absolute effects were determined using baseline risks of SONG Transplant Core outcomes from either national registries or event rates in the control arms of the included trials. All outcomes were assessed using the GRADE certainty of evidence. The GRADE Evidence-to-Decision framework was used to develop recommendations for care and clinical practice points.</div><div>Balanced electrolyte solution compared with normal saline resulted in an 18% reduction in delayed graft function (7 studies, 1306 participants, risk ratio: 0.82; 95% confidence interval [CI]: 0.71–0.94) and no differences across living and deceased donation were evident. In deceased donation, balanced electrolyte solution compared with normal saline has a clinically important decrease in delayed graft function (69 fewer per 1000 patients; 95% CI: 111 to 23 fewer]). The use of balanced electrolyte solution compared with normal saline has an unclear effect on hyperkalemia but it may be no different (66 fewer per 1000 patients; 95% CI: 207 fewer to 136 more). In living donation, the use of balanced electrolyte solutions had very small benefits on the risk of delayed graft function (7 few per 1000 patients; 95% CI: 12 fewer to 2 fewer). In those receiving a living donor kidney transplant, the effects of balanced electrolyte solutions compared with normal saline on hyperkalemia were unclear but are likely to be no different (25 fewer per 1000 patients; 95% CI: 79 fewer to 52 more).</div><div>Balanced electrolyte solutions are recommended for deceased donor transplants, with a moderate certainty of evidence. However, in living donation transplants balanced electrolyte solutions are only suggested with a low degree of certainty of evidence. Further research is needed on patient-centered outcomes and the use of balanced solutions in pediatric populations to optimize kidney transplan","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 8","pages":"Pages 2566-2574"},"PeriodicalIF":5.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Japanese Patients’ Perceptions of Shared Decision-Making in Renal Replacement Therapy","authors":"Yugo Shibagaki ,&nbsp;Tadashi Sofue ,&nbsp;Hiroo Kawarazaki ,&nbsp;Tatsunori Toida ,&nbsp;Tomo Suzuki ,&nbsp;Hiroki Nishiwaki ,&nbsp;Kenichiro Asano ,&nbsp;Hiroyuki Terawaki ,&nbsp;Takafumi Ito ,&nbsp;Hideaki Oka ,&nbsp;Kei Nagai ,&nbsp;Minoru Murakami ,&nbsp;Kojiro Nagai ,&nbsp;Daisuke Komukai ,&nbsp;Takayuki Adachi ,&nbsp;Satoshi Furukata ,&nbsp;Takaaki Tsutsui ,&nbsp;Kiichiro Fujisaki ,&nbsp;Seita Sugitani ,&nbsp;Hideaki Shimizu ,&nbsp;Ryo Sugiyama","doi":"10.1016/j.ekir.2025.05.011","DOIUrl":"10.1016/j.ekir.2025.05.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Shared decision-making (SDM) is a key process in selecting renal replacement therapy (RRT). This study analyzed SDM perceptions, preferences, as well as patient- and facility-level factors influencing SDM perception among Japanese patients with chronic kidney disease (CKD) who selected RRT.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional survey of 475 adult patients with CKD from 49 medical facilities. SDM awareness and recognition, preferences for SDM timing and frequency, discussion content, and desired professional involvement were assessed. Patient- and facility-level factors associated with SDM perceptions were evaluated using multivariable analysis.</div></div><div><h3>Results</h3><div>The mean participant age was 67.4 years. Hemodialysis, peritoneal dialysis, and kidney transplantation were chosen by 71%, 24.4%, and 4.4% of patients, respectively. Although 81.2% recalled SDM occurring during RRT selection, only 4.7% were well aware of SDM before the survey. Patients prioritized discussions about daily life impact, financial burden, and family-related concerns. Most patients preferred SDM initiation when RRT was imminent, and to be conducted over multiple sessions. Many patients valued the involvement of medical social workers and their usual nonnephrologist physicians in addition to nephrologists. Multiple outpatient visits for RRT selection, involving nurse participation and extended consultation times, were significantly associated with SDM perceptions (prevalence ratio [PR]: 1.59, 95% confidence interval [CI]: 1.05–2.42).</div></div><div><h3>Conclusion</h3><div>Many Japanese patients with CKD retrospectively evaluated RRT selection as involving SDM; however, a few were familiar with the concept beforehand. This underscores the importance of establishing systems that facilitate repeated SDM discussions at critical moments for patients. These discussions should emphasize the impact of RRT on patients’ lives and involve a multidisciplinary team.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 8","pages":"Pages 2778-2788"},"PeriodicalIF":5.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Changes on Kidney Histology by a Multiclass Artificial Intelligence Model","authors":"Aleksandar Denic ,&nbsp;Muhammad S. Asghar ,&nbsp;Lucas Stetzik ,&nbsp;Austin Reynolds ,&nbsp;Jaidip M. Jagtap ,&nbsp;Mahesh Kumar ,&nbsp;Aidan F. Mullan ,&nbsp;Andrew R. Janowczyk ,&nbsp;Mariam P. Alexander ,&nbsp;Maxwell L. Smith ,&nbsp;Fadi E. Salem ,&nbsp;Laura Barisoni ,&nbsp;Andrew D. Rule","doi":"10.1016/j.ekir.2025.05.035","DOIUrl":"10.1016/j.ekir.2025.05.035","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic changes in kidney histology are often approximated by using human vision but with limited accuracy.</div></div><div><h3>Methods</h3><div>An interactive annotation tool trained an artificial intelligence (AI) model for segmenting structures on whole slide images (WSIs) of kidney tissue. A total of 20,509 annotations trained the AI model with 20 classes of structures, including separate detection of cortex from medulla. We compared the AI model detections with human-based annotations in an independent validation set. The AI model was then applied to 1426 donors and 1699 patients with renal tumor to calculate chronic changes as defined by measures of nephron size (glomerular volume, cortex volume per glomerulus, and mean tubular areas) and nephrosclerosis (globally sclerotic glomeruli, increased interstitium, increased tubular atrophy (TA), arteriolar hyalinosis (AH), and artery luminal stenosis from intimal thickening). We then assessed whether chronic kidney disease (CKD) outcomes were associated with these chronic changes.</div></div><div><h3>Results</h3><div>During the AI model validation step, the agreement between the AI detections and human annotations was similar to the agreement between human pairs, except that the AI model showed less agreement with AH. Chronic changes calculated solely from AI-based detections associated with low glomerular filtration rate (GFR) during follow-up after kidney donation and with kidney failure after a radical nephrectomy for tumor. A chronicity score based on AI detections was calculated from cortex per glomerulus, percent glomerulosclerosis, TA foci density, and mean area of AH lesions and showed good prognostic discrimination for kidney failure (cross-validation C-statistic = 0.819).</div></div><div><h3>Conclusion</h3><div>A multiclass AI model can help automate quantification of chronic changes on WSIs of kidney histology.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 8","pages":"Pages 2668-2679"},"PeriodicalIF":5.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning for Monoclonal Gammopathies of Renal Significance Risk Stratification Using Clinical and Pathology Data","authors":"Giorgio Cazzaniga ,&nbsp;Giulia Capitoli ,&nbsp;Raffaella Barretta ,&nbsp;Andrew Smith ,&nbsp;Gisella Vischini ,&nbsp;Giuliana Papalia ,&nbsp;Federico Alberici ,&nbsp;Federica Mescia ,&nbsp;Albino Eccher ,&nbsp;Jan Ulrich Becker ,&nbsp;Maarten Naesens ,&nbsp;Lucrezia Furian ,&nbsp;Bernd Schröppel ,&nbsp;Stefania Galimberti ,&nbsp;Fabio Pagni ,&nbsp;Vincenzo L'Imperio","doi":"10.1016/j.ekir.2025.05.007","DOIUrl":"10.1016/j.ekir.2025.05.007","url":null,"abstract":"<div><h3>Introduction</h3><div>The prompt detection of monoclonal gammopathies of renal significance (MGRS) is clinically relevant for the initiation of chemotherapy. Although clinical and laboratory data can suggest the presence of MGRS, renal biopsy still represents the gold standard, despite not always being performed or eventually postponed because it is not deemed useful or informative. In this retrospective study, machine learning (ML) is used to build a tool to assist the prebiopsy risk stratification of MGRS and reinforce the rationale for the histological examination.</div></div><div><h3>Methods</h3><div>The study included a total of 258 patients with monoclonal gammopathy of undetermined significance, of which 168 MGRS cases (65%) and 90 non-MGRS cases (35%) based on the final renal biopsy result.</div></div><div><h3>Results</h3><div>Patients with MGRS were more frequently female (48.2% vs. 28.9%, <em>P</em> = 0.004) and had more frequent Bence Jones proteinuria (73.2% vs. 41.1%, <em>P</em> &lt; 0.001) than non-MGRS cases, with amyloidosis being the most common diagnosis (62%). The ML model achieved an accuracy of 0.79 (95% confidence interval [CI]: 0.67–0.88) and an area under the receiver operating characteristic curve of 0.80 (95% CI: 0.65–0.93) in the validation set. The model is available as a free desktop and Android mobile app (MGRS Interactive Resource for AI-Guided Evaluation, MIRAGE).</div></div><div><h3>Conclusion</h3><div>The ML-based MGRS risk stratification tool can help in the selection of patients with higher probability to have MGRS on renal biopsy, aiming to direct those patients to a complete histological characterization of the disease.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 8","pages":"Pages 2680-2689"},"PeriodicalIF":5.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Phenylacetylglutamine and Cognitive Impairment in CKD","authors":"Hélène Levassort ,&nbsp;Julie Boucquemont ,&nbsp;Sophie Liabeuf ,&nbsp;Solène M. Laville ,&nbsp;Céline Lange ,&nbsp;Luc Frimat ,&nbsp;Christian Combe ,&nbsp;Denis Fouque ,&nbsp;Maurice Laville ,&nbsp;Christian Jacquelinet ,&nbsp;Yves-Edouard Herpe ,&nbsp;Islam Amine Larabi ,&nbsp;Jean-Claude Alvarez ,&nbsp;Natalia Alencar de Pinho ,&nbsp;Marion Pépin ,&nbsp;Ziad A. Massy","doi":"10.1016/j.ekir.2025.05.037","DOIUrl":"10.1016/j.ekir.2025.05.037","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic kidney disease (CKD) leads to the accumulation of uremic toxins (UTs). Studies have suggested that UTs are associated with cognitive impairment (CI) in patients with CKD. Recently, studies reported that phenylacetylglutamine (PAG) contributes to the association between CKD and CI. However, this association has not been investigated in nondialysis-dependent adults with CKD.</div></div><div><h3>Methods</h3><div>The CKD–Renal Epidemiology and Information Network (CKD-REIN) cohort study included 3033 patients with CKD stages 2 to 5. This cross-sectional analysis included those with a PAG measurement and a mini-mental state examination (MMSE) score within 3 months of each other. CI was defined as an MMSE score ≤ 26 out of 30. Logistic regression was used to assess the association between PAG and CI.</div></div><div><h3>Results</h3><div>Of the 2590 patients included (mean [SD] age: 67 [13] years, mean [SD] estimated glomerular filtration rate [eGFR]: 34 [13] ml/min per 1.73 m², median [interquartile range, IQR] PAG level: 2.1 [1.2–3.6] mg/l), 908 (35%) presented an MMSE score ≤ 26 out of 30. After adjustment for sociodemographic factors (age, male sex, and educational level), cardiovascular risk factors, cerebrovascular disease, current depression, eGFR, urinary albumin-to-creatinine ratio (uACR), and UTs known to be associated with CI risk, a 2-fold increase in the PAG level was associated with CI (odds ratio [OR] [95% confidence interval]: 1.12 [1.01–1.23]).</div></div><div><h3>Conclusion</h3><div>This study shows that a higher serum PAG level was associated with CI in nondialysis-dependent adults with CKD and highlight a new UT associated with CI in patients with CKD. Further studies are needed to confirm the causal nature of the association and to explore strategies for reducing serum PAG levels to protect cognition.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 8","pages":"Pages 2720-2731"},"PeriodicalIF":5.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}