Kidney & blood pressure research最新文献

{"title":"Global Trends and Projections in Chronic Kidney Disease Burden from Diabetes, Hypertension, and Glomerulonephritis: A Population-Based Study.","authors":"Kexin Zhang, Chengxia Kan, Fang Han, Qiming Fan, Yuqun Wang, Xuan Li, Ruiyan Pan, Zhentao Guo, Ningning Hou, Xiaodong Sun","doi":"10.1159/000550353","DOIUrl":"10.1159/000550353","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease (CKD) is a major global health challenge contributing to substantial morbidity, mortality, and healthcare burden. This study analyzed global, regional, and national trends in CKD due to type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), hypertension, and glomerulonephritis from 1990 to 2021, with projections to 2045.</p><p><strong>Methods: </strong>This population-based study used data from the Global Burden of Disease (GBD) 2021 across 204 countries and territories. The CKD burden by etiology was evaluated using prevalence, incidence, deaths, disability-adjusted life years (DALYs), and corresponding age-standardized rates (ASPR, ASIR, ASMR, ASDR). Temporal trends were assessed using regression and age-period-cohort models, and health inequalities were analyzed across regions and sociodemographic levels.</p><p><strong>Results: </strong>In 2021, global CKD prevalence reached 673.7 million cases, primarily driven by T2DM and hypertension. T2DM had the highest ASPR (1,259.63) and ASIR (23.07). From 1990 to 2021, ASPRs for CKD from T1DM and glomerulonephritis initially rose but recently declined (T1DM, annual percent change [APC]: -2.51% from 2019 to 2021; glomerulonephritis, APC: -0.53% from 2015 to 2019). However, ASIRs for all four etiologies continued to increase. In 2021, CKD caused 1.53 million deaths, with T2DM contributing most to deaths and DALYs, having the highest ASMR (5.72) and ASDR (131.08). While ASMR increased for all CKD types, the ASDR for T1DM-related CKD initially declined but has risen since 2012, whereas ASDRs for CKD due to T2DM, hypertension, and glomerulonephritis have continuously increased. Middle-social development index (SDI) region saw the largest increases in CKD prevalence and incidence due to T2DM, primarily driven by population growth (69.93% of prevalence rise) and aging (50.05% of deaths, 48.16% of DALYs). While epidemiological changes reduced prevalence by 11.10%, they contributed 23.13% to the incidence increase. High-SDI regions had the fastest growth in ASMR and ASDR. South Asia led in prevalence growth, while East Asia experienced the highest incidence increases, mainly due to aging, highlighting significant regional disparities in CKD drivers. Inequality analysis indicated that wealthier countries had better outcomes for T2DM- and hypertension-related CKD, whereas poorer countries appeared to fare better for T1DM- and glomerulonephritis-related CKD. Projections to 2045 suggest continued increases in CKD from T2DM and hypertension, with potential declines in T1DM- and glomerulonephritis-related CKD.</p><p><strong>Conclusion: </strong>The global CKD burden has markedly increased from 1990 to 2021, primarily due to T2DM and hypertension. Regional disparities highlight the necessity for targeted public health interventions.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"72-90"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12890268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cumulative Vascular Burden: The Prognostic Value of a Time-Weighted Cardio-Ankle Vascular Index in Haemodialysis Patients.","authors":"Roberto Casale, Lida Tartaglione, Francesco Pesce, Sandro Mazzaferro, Silvia Lai, Sebastiano Sciarretta, Maria Luisa Muci, Antonio Bellasi, Gianluigi Zaza, Silverio Rotondi","doi":"10.1159/kbr/adjag007","DOIUrl":"10.1159/kbr/adjag007","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease and end-stage renal disease are burdened by extremely high cardiovascular mortality. The cardio-ankle vascular index (CAVI) is a blood-pressure-independent marker of arterial stiffness, but a single measurement may not reflect the time-dependent nature of vascular remodelling in haemodialysis. We hypothesized that a time-weighted CAVI (twCAVI), integrating arterial stiffness with dialysis vintage, would better predict all-cause mortality.</p><p><strong>Methods: </strong>In this observational cohort study, 94 maintenance haemodialysis patients were followed from February 2016 to December 2024. Arterial stiffness was assessed by CAVI, and twCAVI was defined as mean CAVI × dialysis vintage (months). After preprocessing and feature selection, the association between arterial stiffness and overall survival over approximately 8 years was examined using a Cox proportional hazards model. Internal validity was assessed by 1,000 bootstrap iterations and expressed via Harrell's concordance index (C-index) and time-dependent area under the curve (AUC).</p><p><strong>Results: </strong>The final model retained six predictors: sex, vascular access, creatinine, alkaline phosphatase (ALP), ferritin, and twCAVI. In the multivariate model, male sex (HR 2.56, p = 0.0018), ALP (HR 1.01, p = 0.0082), ferritin (HR 1.002, p = 0.0067) and twCAVI (HR 1.0021, p = 0.0464) were independently associated with higher mortality, while higher creatinine was protective (HR 0.87, p = 0.0445). Central venous catheter use showed a borderline trend towards increased risk compared with arteriovenous fistula (HR 1.68, p = 0.0509). Bootstrap validation yielded a median C-index of 0.75 (95% confidence interval [CI] 0.68-0.83), with time-dependent AUCs generally ≥0.80 up to 102 months. Notably, exploratory survival analyses revealed an age-dependent inverse association between phosphorus levels and mortality, supporting the reverse epidemiology hypothesis in the elderly.</p><p><strong>Conclusion: </strong>twCAVI, capturing the cumulative vascular burden risk, is a predictor of mortality in haemodialysis patients and improves long-term risk discrimination. A proof-of-concept web-based calculator was developed to facilitate the educational exploration of this metric.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"903-914"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906551","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":"Influence of Concomitant Opioids on Difelikefalin Treatment Outcomes in Adults with Moderate-to-Severe Pruritus on Maintenance Hemodialysis: Exploratory Analyses.","authors":"James O Burton, Satkiran Grewal, Thilo Schaufler, Despina Ruessmann, Murray Lowe, Warren Wen, Steven Fishbane","doi":"10.1159/000549648","DOIUrl":"10.1159/000549648","url":null,"abstract":"<p><strong>Introduction: </strong>Difelikefalin (DFK) is approved to treat chronic kidney disease-associated pruritus (CKD-aP) in adults undergoing maintenance hemodialysis. The influence of concomitant opioid use on DFK treatment outcomes remains uncertain.</p><p><strong>Methods: </strong>Exploratory analyses were conducted from the phase 3, placebo (PBO)-controlled KALM-1 and KALM-2 trials (datasets pooled), and the phase 3, open-label, single-arm Study 3105. Each trial assessed the safety and efficacy of DFK 0.5 µg/kg in adults with moderate-to-severe CKD-aP. We report key endpoints from the primary studies, including reduction in itch intensity (Worst Itching Intensity Numerical Rating Scale [WI-NRS]), and improvements in itch-related quality of life (QoL; 5-D itch and Skindex-10), according to concomitant opioid use (+O or -O).</p><p><strong>Results: </strong>In KALM-1/KALM-2, 24.2% of participants on DFK and 30.4% on PBO were taking concomitant opioids. Regardless of opioid use, a greater estimated percentage of those receiving DFK achieved ≥3- or ≥4-point clinically relevant reductions in itch intensity (WI-NRS; p < 0.05), or complete response (≥80% weekly mean WI-NRS scores of 0 or 1) by week 12, versus PBO. Greater improvements in itch-related QoL were also reached with DFK, versus PBO, irrespective of concomitant opioid use. With either treatment, nonfatal serious TEAEs were more common among concomitant opioid users (DFK+O: 44.7% vs. DFK-O: 19.0%; PBO+O: 38.0% vs. PBO-O: 15.9%), as were severe TEAEs. In Study 3105, 31% were taking concomitant opioids.</p><p><strong>Conclusion: </strong>DFK reduced itch intensity and improved QoL, regardless of concomitant opioid use. Similar concomitant opioid-dependent safety findings were observed. With or without concomitant opioid use, DFK demonstrated considerable efficacy that improved QoL. Increased TEAEs with concomitant opioid use with either treatment suggests careful medication management is advisable.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"10-26"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12803522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphometric and Functional Evaluation of Nonrenal Vasculature in Female and Male PKD/Mhm (Cy/+) Rats.","authors":"Baoer Liu, Ming Ma, Patricia Kraft, Tobias Mayer, Alex Ali Sayour, Kim Bierhoff, Tilmann Stephan Clanget, Maik Brune, Franz Schaefer, Matthias Karck, Gábor Szabó, Sevil Korkmaz-Icöz","doi":"10.1159/000550553","DOIUrl":"10.1159/000550553","url":null,"abstract":"<p><strong>Introduction: </strong>Polycystic kidney disease (PKD) is a genetic disorder characterized by renal enlargement due to cyst formation. Besides cystic complications, patients with autosomal dominant PKD (ADPKD) can develop vascular abnormalities. We investigated the impact of ADPKD on aortic morphometry and function in female and male PKD rats.</p><p><strong>Methods: </strong>Thoracic aortic rings were obtained from six-month-old female (n = 10; 307 ± 4 g) and male (n = 10; 470 ± 24 g) PKD/Mhm (Cy/+) rats, as well as age-matched control female (n = 9; 312 ± 6 g) and control male (+/+) (n = 13; 460 ± 14 g) rats. Vascular function was evaluated ex vivo using organ baths. Biomarkers of renal function were evaluated, and histology was performed.</p><p><strong>Results: </strong>PKD female and PKD male rats showed elevated serum creatinine levels compared to their respective controls (PKD female: 50.0 ± 1.7 μmol/L vs. control female: 43.9 ± 2.1 μmol/L; PKD male: 178.7 ± 21.0 μmol/L vs. control male: 40.4 ± 1.3 μmol/L, p < 0.05), and these levels were found to be higher in the PKD males than in the PKD females (p < 0.0001). Endothelial dysfunction, characterized by reduced maximum relaxation to acetylcholine, was observed in the PKD males compared to control males (55 ± 2% vs. 77 ± 1%, p < 0.05). Additionally, contractile responses to phenylephrine and high potassium were decreased in PKD male compared to control male. Morphometric analysis revealed increased wall thickness, wall cross-sectional area normalized to body weight, and wall:lumen area ratio in PKD male aortas compared to control male. Additionally, PKD male showed increased cleaved poly(ADP-ribose) polymerase-1 immunoreactivity compared to control males. All these parameters were unchanged in PKD females compared to control females.</p><p><strong>Conclusion: </strong>Six-month-old male rats with PKD, but not females, display endothelial dysfunction, impaired smooth muscle contraction/relaxation, pathological changes in aortic morphometry, and increased apoptosis, providing a model for studying vascular complications in ADPKD.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"128-140"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093356","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":"Association of Body Mass Index Trajectories with Kidney Stone Disease: An Analysis Based on the NHANES Database.","authors":"Weihang Song, Chunfeng Zhang, Zhenhui Li, Kuo Ma, Zeyu Li","doi":"10.1159/000553433","DOIUrl":"10.1159/000553433","url":null,"abstract":"<p><strong>Background: </strong>Body mass index (BMI), a key indicator of obesity, has been shown by numerous studies to be associated with the risk of kidney stone disease (KSD). However, existing research has predominantly focused on BMI measurements at single time points, thereby failing to adequately capture the long-term impact of dynamic changes in BMI on KSD risk.</p><p><strong>Methods: </strong>Data for this study were derived from the NHANES database. Latent class trajectory modeling was employed to identify distinct BMI trajectories. Logistic regression models were utilized to analyze the relationship between these trajectories and KSD risk. Subgroup analyses were conducted to examine potential discrepancies in the BMI trajectory-KSD association across genders.</p><p><strong>Results: </strong>Four BMI trajectories were identified: slight increase (class 1), rapid increase (class 2), rapid increase to decrease (class 3), and slight decrease (class 4). Compared to individuals in the slight increase trajectory, those experiencing a rapid increase to decrease trajectory (OR = 1.34, 95% CI: 1.04-1.70, p = 0.020) and a slight decrease trajectory (OR = 1.38, 95% CI: 1.02-1.83, p = 0.030) exhibited an appreciably higher prevalence of KSD. Subgroup analysis revealed that, in the fully adjusted model, compared with males in class 1, those in classes 3/4 were associated with a 47% and 60% increased risk of KSD, respectively.</p><p><strong>Conclusion: </strong>BMI trajectories with a rapid increase to decrease and a slight decrease were markedly associated with increased KSD risk, which was exclusively observed in males. This underscores the importance of monitoring dynamic changes in BMI and developing male-specific interventions.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"705-714"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13466442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nobiletin from Xiaoyu Xiezhuo Decoction: Restoring Mitochondrial Dynamics and Alleviating Renal Ischemia-Reperfusion Injury via M1 Macrophage Modulation.","authors":"Yuan Yuan, Jing Huang, Yinchao Zhou, Zhibo Weng, Yiru Weng, Zhouzhou Dong","doi":"10.1159/000551502","DOIUrl":"10.1159/000551502","url":null,"abstract":"<p><strong>Introduction: </strong>There have been reports that the traditional Chinese medicine formula Xiaoyu Xiezhuo Decoction (XYXZD) protects against kidney injury. Its possible mechanisms in renal ischemia-reperfusion injury (IRI) remain unclear, though. Investigating XYXZD's function and possible therapeutic effects on renal IRI is the goal of this investigation.</p><p><strong>Methods: </strong>Liquid chromatography-mass spectrometry and network pharmacology were applied to identify key target genes associated with XYXZD and renal IRI. Molecular docking was employed to forecast the binding affinity of bioactive compounds to these targets. The effects of nobiletin (NOB) on macrophage polarization, inflammatory cytokine production, mitochondrial function, and oxidative stress were evaluated. The impact of NOB on HK-2 mitochondrial dynamics through M1 macrophage polarization was evaluated via the cell counting kit-8 assay, enzyme-linked immunosorbent assay, Western blotting, and transmission electron microscopy.</p><p><strong>Results: </strong>Network pharmacology analysis identified matrix metalloproteinase-9 (MMP9) and poly(ADP-ribose) polymerase 1 (PARP1) as key regulatory factors linking macrophage polarization and mitochondrial function. Molecular docking revealed a strong binding affinity between NOB and MMP9. NOB reduced M1 macrophage polarization, along with the downregulation of pro-inflammatory cytokines interleukin-1 beta and interleukin-6. In HK-2 cells, NOB mitigated mitochondrial dysfunction by modulating M1 macrophage polarization, reducing reactive oxygen species production, and restoring mitochondrial dynamics.</p><p><strong>Conclusion: </strong>By preventing M1 macrophage polarization, lowering inflammation, and reestablishing mitochondrial homeostasis in renal tubular epithelial cells, this study showed that NOB has renoprotective benefits. These results provided fresh perspectives on NOB's potential as a treatment for renal IRI.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"285-298"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13197149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147474407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Platelet Count and Congestive Heart Failure in Chronic Kidney Disease Participants: Results from NHANES (2007-2018).","authors":"Yuchao Wang, Jiawei Zheng, Xin Cheng, Ping Han, Lihong Wen, Chaofan Yin","doi":"10.1159/kbr/adjag002","DOIUrl":"10.1159/kbr/adjag002","url":null,"abstract":"<p><strong>Background: </strong>The primary objective of this study was to examine the association between platelet count (PLT) and congestive heart failure (CHF) in patients with chronic kidney disease (CKD).</p><p><strong>Methods: </strong>Data from the National Health and Nutrition Examination Survey (NHANES, 2007-2018) were used to investigate the association between PLT and CHF in patients with CKD. Demographics, laboratory, and comorbidities data were analyzed. Multivariable logistic regression, stratified analysis, curve fitting, and subgroup analyses were performed to assess the association between PLT and CHF.</p><p><strong>Results: </strong>A total of 2,540 participants were included, comprising 230 with CHF and 2,310 without CHF. In multivariable logistic regression analysis, after adjusting for various confounders across three models, PLT was inversely associated with CHF. Each 10 × 103/μL increase in PLT was associated with lower odds of CHF in the crude model (OR 0.918, 95% CI: 0.897-0.940). The PLT-CHF relationship followed a linear trend (p for non-linearity = 0.567). Subgroup analysis revealed a significant interaction between female sex and CHF risk (p for interaction < 0.05).</p><p><strong>Conclusion: </strong>PLT was independently associated with CHF in patients with CKD. Each 10 × 103/μL increment in PLT corresponded to lower odds of CHF in model III.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"877-886"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025108","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":"Comparative Analysis of Clinical and Pathological Traits in IgA Nephropathy Patients with Nephrotic Syndrome or Nephrotic Range Proteinuria.","authors":"Sang Hun Eum, Eun Sil Koh, Byung Ha Chung, Tae Hyun Ban, Ji Won Min, Hyung Wook Kim, Yu Ah Hong, Bum Soon Choi, Seok Joon Shin, Young Soo Kim, Hye Eun Yoon","doi":"10.1159/kbr/adjag009","DOIUrl":"10.1159/kbr/adjag009","url":null,"abstract":"<p><strong>Introduction: </strong>IgA nephropathy (IgAN) with nephrotic-range proteinuria (NRP) comprises two distinct presentations - with and without hypoalbuminemia, and comparative outcome data are limited, particularly for patients with preserved serum albumin.</p><p><strong>Methods: </strong>From a multicenter cohort of patients with IgAN and NRP, 127 patients were divided into a nephrotic syndrome (NS) group (NRP with hypoalbuminemia) and an NRP with normal serum albumin (NRP-NA) group. We compared baseline features, 1-year outcomes, and progression to a composite endpoint of a ≥30% decline in estimated glomerular filtration rate (eGFR) or progression to end-stage kidney disease and evaluated predictors of the composite endpoint. Immunosuppressive exposure was ascertained, and proteinuria response was classified as complete or partial remission.</p><p><strong>Results: </strong>The NS group showed higher levels of C-reactive protein, lipids, and proteinuria and exhibited more pronounced diffuse foot process effacement than the NRP-NA group. After 1 year, the NS group demonstrated greater eGFR recovery and proteinuria reduction than the NRP-NA group. Overall remission rates were similar (75.61% vs. 81.71%), but complete remission was three times more frequent in the NS group (29.27% vs. 9.76%, p = 0.009) whereas the NRP-NA group more often remained in partial remission (46.34% vs. 71.95%, p = 0.009). Composite endpoint-free survival was lower in the NS group (p = 0.010), but this difference did not persist after adjustment for baseline eGFR (hazard ratio [HR], 1.586; 95% confidence interval [CI], 0.883-2.849; p = 0.123). In multivariable analysis, baseline eGFR was the dominant predictor of the composite outcome (HR per mL/min/1.73 m2, 0.978; 95% CI, 0.967-0.989; p < 0.001), whereas renin-angiotensin system inhibition was independently associated with a lower risk of kidney events (HR, 0.357; 95% CI, 0.146-0.874; p = 0.024).</p><p><strong>Conclusion: </strong>IgAN patients with NS and those with NRP-NA showed distinct patterns of proteinuria response, and the apparent difference in long-term kidney outcome did not persist after adjustment for baseline kidney function. Renin-angiotensin system inhibition was independently associated with a lower risk of kidney disease progression.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"936-952"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081395","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":"From Clot Prevention to Kidney Injury: Revisiting Anticoagulant-Related Nephropathy.","authors":"Irene Martin Capon, Paolo Nikolai So, Tiffany Caza, Sayna Norouzi, Edgar Lerma, Harish Seethapathy, Sandra Karanović Štambuk, Paul E Hanna, Nasim Wiegley, Mohamed Hassanein","doi":"10.1159/000550599","DOIUrl":"10.1159/000550599","url":null,"abstract":"<p><strong>Background: </strong>Anticoagulant-related nephropathy (ARN) is a serious and often underrecognized complication of anticoagulant therapy. Initially associated with vitamin K antagonists such as warfarin, ARN has also been increasingly linked to direct oral anticoagulants, including dabigatran, rivaroxaban, edoxaban, and apixaban. The condition is characterized by acute kidney injury (AKI), macroscopic hematuria, glomerular hemorrhage, and red blood cell casts within renal tubules.</p><p><strong>Summary: </strong>Although once considered rare, growing evidence suggests ARN is more common than previously believed, especially in patients with preexisting chronic kidney disease (CKD). The prognosis is often poor: over half of affected patients fail to recover baseline kidney function within a year, and non-recovering patients face markedly increased mortality, with some studies reporting a 1-year mortality rate as high as 39%. Treatment strategies have included anticoagulant withdrawal, supportive measures, and corticosteroids, yet no standardized or definitive therapy has been established. This review examines current data on the epidemiology, pathophysiology, diagnosis, and therapeutic options for ARN.</p><p><strong>Key messages: </strong>ARN is an increasingly recognized cause of AKI in anticoagulated patients, particularly those with CKD. The condition is often associated with incomplete or absent renal recovery and significantly higher mortality in non-recovering patients. Therefore, early recognition and appropriate risk stratification are crucial, although current treatment options remain largely supportive. Further research is needed to establish validated diagnostic criteria and effective therapeutic strategies.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"151-166"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052653","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":"Detection of Nondiabetic Kidney Disease in Patients with Diabetes Using Machine Learning and Electronic Medical Record Data.","authors":"Zhongyu Liu, Chunyang Li, Jia Yao, Zhiye Ying, Ling Li, Ping Fu, Xiaoxi Zeng","doi":"10.1159/000551589","DOIUrl":"10.1159/000551589","url":null,"abstract":"<p><strong>Introduction: </strong>The identification of nondiabetic kidney disease (NDKD) in diabetic patients is critically important. Unlike diabetic nephropathy, NDKD often requires additional therapeutic interventions beyond standard diabetes care. There is a need to develop computational methods using electronic medical record data to identify NDKD in diabetic patients for whom kidney biopsy is not an option.</p><p><strong>Methods: </strong>The study included 1,136 diabetic patients who underwent kidney biopsy at a tertiary teaching hospital. We collected 103 parameters from electronic medical records, including demographic characteristics, physical examination results, laboratory tests, and the status of diabetic retinopathy. We developed seven models to detect NDKD, including k nearest neighbors, random forest, extreme gradient boosting (XGB), LASSO logistic regression, support vector machine, naïve Bayes, and multilayer perceptron (MLP), in the training set (n = 908) and compared their performances in the testing set (n = 228). The SHapley Additive exPlanations (SHAP) approach was used to analyze the importance of features.</p><p><strong>Results: </strong>Biopsy-confirmed NDKD was present in 53% of the 1,136 participants. In the testing set, the area under the receiver operating characteristic curve (AUC) for NDKD detection using XGB, LASSO regression, and MLP reached 0.8, with performances that were stable regardless of whether variable normalization was performed. Among them, XGB revealed the highest AUC (0.833; 95% CI: 0.800-0.864) without feature normalization, which was statistically superior to the other models according to DeLong's tests. After feature normalization, SVM achieved the highest AUC of 0.841 (95% CI: 0.817-0.861) among all models. In addition to established predictive factors for NDKD (e.g., hematuria and absence of diabetic retinopathy), SHAP analysis identified several features, such as low IgG levels, that contributed significantly to the differentiation models.</p><p><strong>Conclusion: </strong>Despite performance variations in different modeling techniques, machine learning models may have the potential to facilitate the detection of NDKD for patients with contraindications for kidney biopsy. Further efforts are warranted to improve accuracy and facilitate their translation into clinical practice.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"326-339"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147480871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}