Nephron最新文献

{"title":"Navigating Disparities and Overcoming Barriers to Access Diabetic Kidney Disease Therapies: A Proposed Multifactorial Approach.","authors":"Romela Petrosyan, A Enrique Caballero, Tracey L Henry, Adam R Puchalski","doi":"10.1159/000548904","DOIUrl":"10.1159/000548904","url":null,"abstract":"<p><p><p>Background: Diabetic kidney disease (DKD) is a serious complication arising from long-term diabetes, disproportionately affecting historically marginalized populations, such as racial and ethnic minority groups, populations with low socioeconomic status, or a lower level of education. This review explores the causes of these disparities and barriers to accessing DKD therapies and proposes solutions. Summary: Socioeconomic factors like lack of health insurance, low income, and limited health literacy significantly hinder access to DKD therapies for marginalized communities. Additionally, inadequate access to healthcare services further exacerbates the issue. Clinical factors also contribute to the inequity. Under-recognition of DKD, under-prescription of effective medications, and a lack of a patient-centered healthcare environment are prominent concerns. Implicit bias among healthcare professionals may also play a role. Patient factors include limited awareness of DKD, challenges with treatment adherence, and frequent healthcare interruptions. Policy interventions like the Inflation Reduction Act, expanding health insurance coverage, and increasing reimbursement for DKD therapies can improve affordability and access. Additionally, a shift toward preventive care models is crucial. Clinical interventions focus on improving early detection, accurate diagnosis, and proper management of DKD. Educating healthcare providers about the benefits of DKD therapies and implementing value-based kidney care programs are essential steps. Patient interventions involve raising awareness about DKD, implementing culturally appropriate educational programs, and fostering community-based support systems. Key Messages: Addressing these disparities requires a multipronged approach involving policy changes, improved healthcare delivery, and patient education. This collaborative effort can ensure equitable access to DKD therapies and improve health outcomes for all populations. </p>.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"131-140"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12707861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513636","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":"L-Glutamine-Induced Acute Kidney Injury: A Clinical Observation.","authors":"Soerajja Bhoelan, Serife Kürül, Charlotte G Krol, Dominque van Midden, Rene Bakker","doi":"10.1159/000548247","DOIUrl":"10.1159/000548247","url":null,"abstract":"<p><strong>Introduction: </strong>L-Glutamine is increasingly used as a dietary supplement and its use is, as is the case with other amino acids, considered safe. L-Glutamine is the most abundant amino acid in the human body and is involved in many metabolic reactions. Within the kidney L-Glutamine has an important role in the generation of ammonia and bicarbonate.</p><p><strong>Case presentation: </strong>We report a case of acute kidney injury (AKI) as a result of tubular damage in a patient who used 18 grams of L-Glutamine on a daily basis. Possible mechanisms are proposed of which increased single nephron ammonia production and toxicity seems most likely cause of AKI.</p><p><strong>Conclusion: </strong>We advise cautious use of L-Glutamine supplements in elderly patient with an already compromised kidney function.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"47-51"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192183","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":"Human Kidney Organoids to Uncover Preterm Birth-Associated Low Nephron Endowment.","authors":"Bartholomeus T van den Berge, Bart Smeets, Michiel F Schreuder, Jitske Jansen","doi":"10.1159/000552561","DOIUrl":"10.1159/000552561","url":null,"abstract":"<p><strong>Background: </strong>Preterm birth disrupts kidney development, resulting in reduced nephron number and structural immaturity of glomeruli and podocytes that increases the risk of hypertension, proteinuria, and subsequently chronic kidney disease (CKD) later in life. Since nephrogenesis ceases around 36 weeks of gestation, preterm infants cannot generate new nephrons after birth, making them vulnerable to long-term renal dysfunction. Unravelling the mechanisms behind this impaired development has been limited by the complexity of human nephrogenesis and the lack of physiologically relevant experimental models.</p><p><strong>Summary: </strong>Recent advances in human-induced pluripotent stem cell-derived kidney organoids have made it possible to model nephrogenesis in vitro. These organoids replicate key processes such as nephron differentiation, ureteric bud branching, and kidney vascularization, allowing detailed study of kidney development and injury. Moreover, molecular interventions - including retinoic acid (RA), glial-cell-line-derived neurotrophic factor (GDNF), and insulin-like growth factor 1 (IGF1) - show the potential to enhance nephron formation and protect against kidney injury.</p><p><strong>Key messages: </strong>(1) Kidney organoids provide a powerful, human-relevant system to study nephrogenesis and CKD mechanisms. (2) Integration of the ureteric bud and enhanced vascularization significantly improves organoid maturity towards a more in vivo-like state. (3) Targeted molecular interventions such as RA, GDNF, and IGF1 offer potential strategies to enhance nephron endowment and mitigate CKD risk in preterm-born individuals and may be studied using kidney organoids.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"683-694"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147974045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Physiology and Pathophysiology of Branched-Chain Amino Acids in the Kidney.","authors":"Louis J Delinois, Samaneh DiMartino, Sian E Piret","doi":"10.1159/000551377","DOIUrl":"10.1159/000551377","url":null,"abstract":"<p><strong>Background: </strong>Kidneys require large amounts of energy to maintain function and are highly metabolically active. Acute kidney injury (AKI) and diseases including chronic kidney disease (CKD), diabetic kidney disease (DKD), and polycystic kidney disease (PKD) are strongly associated with metabolic disturbances.</p><p><strong>Summary: </strong>While most research to date has focused on glucose and fatty acid metabolism, the catabolism of the branched-chain amino acids (BCAAs) leucine, isoleucine, and valine is an emerging area of importance across different kidney pathologies. BCAAs can be used in protein synthesis or catabolized to provide tricarboxylic acid (TCA) cycle intermediates. BCAAs and their metabolites can also act as signaling molecules. Disturbances of BCAA catabolism have recently been described in AKI, CKD, DKD, and PKD, driven by both transcriptional and posttranslational mechanisms. This results in accumulation of BCAAs in the kidneys and the loss of a source of TCA cycle intermediates. In addition, accumulated BCAAs, especially leucine, can activate mechanistic target of rapamycin complex 1 (mTORC1) signaling. In addition to the described disturbances in BCAA catabolism, recent preclinical studies have shown that reactivation of BCAA catabolism could be a potential therapeutic strategy.</p><p><strong>Key messages: </strong>This review will describe the process of BCAA catabolism and its disturbances in AKI, CKD, DKD, and PKD.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"545-553"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365872","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":"Recurrence of Glomerular Diseases after Kidney Transplantation: What Do We Know New?","authors":"Emilio Rodrigo, Lara Belmar, José Luis Pérez-Canga","doi":"10.1159/000543268","DOIUrl":"10.1159/000543268","url":null,"abstract":"<p><strong>Background: </strong>The recurrence of primary glomerulonephritis (GN) following kidney transplantation poses a significant threat to graft survival. To enhance kidney transplant outcomes, we must lessen the burden of recurrence. In recent years, there has been progress in understanding the incidence, risk factors for recurrence, pathophysiology, biomarkers, and therapeutics, making it worthwhile to conduct an update on primary GN that may recur following kidney transplantation.</p><p><strong>Summary: </strong>We conducted a narrative review of the literature on the novel discoveries of primary GN that can recur following kidney transplantation. To summarize, developing a broad consensus on recurrence diagnosis would greatly advance our understanding, and its development would be a valuable collaborative effort. The key risk factors for recurrence have been better understood, particularly in individuals with complement-related or monoclonal gammopathy-related recurrent membranoproliferative GN. Furthermore, we can identify better recurrent IgA nephropathy patients who are more likely to experience graft loss. New biomarkers for membranous nephropathy (anti-PLA2R-Ab) and focal and segmental glomerulosclerosis (anti-nephrin-Ab) can assist in identifying and monitoring patients at risk of recurrence. Regarding therapy, the focal and segmental glomerulosclerosis consensus will enhance recurrence treatment. Some complement inhibitors and anti-CD38 monoclonal antibodies are already promising in treating and healing recurrent C3 glomerulopathy and focal and segmental glomerulosclerosis, respectively. Finally, new drugs developed specifically to treat IgA nephropathy in the native kidney will also change the outcome of IgA nephropathy recurrence.</p><p><strong>Key messages: </strong>Although there has been progress in understanding the recurrence of primary GN following kidney transplantation, a worldwide effort should be undertaken to gather research that will allow for improved diagnosis, monitoring, and management of these patients.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"457-468"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Combining Exercise with Pharmacologic Management of Chronic Kidney disease: From Sodium-Glucose Co-Transporter-2 and Glucagon-Like Peptide-1 to Broader Therapeutic Strategies.","authors":"Thomas J Wilkinson, Greg Biddle, Emily James","doi":"10.1159/000551510","DOIUrl":"10.1159/000551510","url":null,"abstract":"<p><strong>Background: </strong>Given the exceptional evolution of pharmacological approaches to chronic kidney disease (CKD) management and their potential interactions with lifestyle, in this review, we describe the intersection of exercise and pharmacotherapy and the possible role of exercise training as an adjunct management option to optimise glucose-lowering therapies (GLTs) in people living with diabetes and CKD.</p><p><strong>Summary: </strong>Exercise remains a cornerstone intervention for individuals living with CKD and diabetes, providing well-established benefits for cardiovascular health, metabolic regulation, and preservation of physical function. While GLTs, including sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, offer significant promise, these pharmacologic advances must be contextualised within a broader lifestyle framework to achieve optimal outcomes. Future research should prioritise strategies that integrate pharmacotherapy with structured exercise programs, while accounting for patient-specific factors such as comorbidities, frailty, and functional limitations. Implementation science will be critical to translate these findings into routine care, leveraging multidisciplinary teams, digital health tools, and behavioural support. Ultimately, success will depend on integrative, person-centred care models that align pharmacologic and lifestyle interventions to enhance quality of life, reduce disease burden, and improve long-term outcomes for people with CKD and diabetes.</p><p><strong>Key messages: </strong>Exercise and GLTs share complementary mechanisms, such as improvements in insulin sensitivity, inflammation, and body composition. Yet, the synergistic potential of combining these interventions warrants further investigation through high-quality trials and mechanistic studies. Current evidence is encouraging but insufficient to confidently guide clinical practice.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"533-544"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147474459","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":"Molecular Insights into the Immunogenetic Pathways of Diabetic Kidney Disease.","authors":"Cui Yu, Chaoqun Xiong, Kang Xie, Zuyao Chen, Enqi Liu, Lizhuo Wang, Jialin Gao","doi":"10.1159/000551516","DOIUrl":"10.1159/000551516","url":null,"abstract":"<p><strong>Background: </strong>Diabetic kidney disease (DKD), a major microvascular complication of diabetes, is increasingly recognized as a chronic inflammatory disorder driven by immune dysregulation.</p><p><strong>Summary: </strong>This review examines key immunogenetic pathways in DKD, focusing on genetic variants affecting innate and adaptive immunity. We explore how polymorphisms in genes regulating immune cell function, cytokine production, and inflammatory signaling contribute to renal damage. Recent evidence demonstrates that these immunogenetic factors significantly influence DKD development and progression.</p><p><strong>Key messages: </strong>The pathogenesis of DKD is profoundly influenced by an individual's genetic predisposition to immune dysregulation. Numerous genetic variants can exacerbate inflammatory responses, promoting disease development. A deeper understanding of these immunogenetic pathways not only clarifies the pathophysiology of DKD but also opens avenues for novel biomarker discovery and the development of targeted, personalized immunomodulatory therapies.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"554-572"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609385","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":"Discovery Pipeline for Acute Kidney Injury: Molecules, Mechanisms, Models, and Targets.","authors":"Tanima Chatterjee, Joseph Rutkowski, Danielle E Soranno, Eibhlin Goggins, Mark Okusa, Stefania Prenna, Vincenzo Cantaluppi, Abolfazl Zarjou","doi":"10.1159/000549795","DOIUrl":"10.1159/000549795","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) represents a multifaceted clinical syndrome marked by precipitous loss of kidney function, high morbidity and mortality, and a strong propensity for progression to chronic kidney disease. Collectively, these challenges underscore the imperative to delineate conserved molecular and signaling networks that are uniformly engaged across diverse AKI etiologies.</p><p><strong>Summary: </strong>Herein, we survey five emerging research domains poised to transform AKI pathophysiology and therapeutic paradigms. First, lymphatic network remodeling has been implicated as a critical determinant of renal immunodynamics and interstitial fluid homeostasis, whereby modulation of VEGF-C/D signaling reshapes immune cell trafficking and fibrogenic responses. Second, we will cover emerging evidence that positions macrophage ferritin heavy chain as a key regulator of macrophage phenotype and subsequent kidney ferroptosis susceptibility via coordinated regulation of synuclein-⍺, and Spic. Third, we will emphasize incorporating development as a biological variable into experimental design based on evidence that identifies age-dependent divergences in injury susceptibility, and progression of disease. Fourth, we cover mechanosensitive ion channels that are activated by therapeutic ultrasound offering novel opportunities to harness the cholinergic anti-inflammatory pathway for nephroprotection. Finally, targeting tubular epithelial cell senescence and mitochondrial bioenergetics as a promising approach to limit progression of kidney disease will be discussed.</p><p><strong>Key messages: </strong>Collectively, these emerging mechanisms deepen our understanding of AKI pathophysiology and unveil novel therapeutic targets with the potential to transform the treatment landscape.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"173-183"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12772422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145636047","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":"The Effectiveness of Lesion Detection for Immunoglobulin G4-Related Kidney Diseases by Diffusion-Weighted Imaging.","authors":"Hidenori Amaike, Masatoshi Kanda, Hirotsugu Yamazaki, Koki Nakamura, Li Ma, Ken Nagahata, Hiroyuki Nakamura, Arata Osanami, Naoya Yama, Masamitsu Hatakenaka, Masato Furuhashi, Hiroki Takahashi","doi":"10.1159/000547628","DOIUrl":"10.1159/000547628","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study was to compare the efficacy of magnetic resonance imaging (MRI) with that of plain or contrast-enhanced computed tomography (CT) in the detection of renal parenchymal and pelvic lesions of immunoglobulin G4-related kidney disease (IgG4-RKD).</p><p><strong>Methods: </strong>Patients with IgG4-RKD and controls, who performed plain, contrast-enhanced CT and MRI around the kidney region in our hospital, were enrolled. The diagnosis of IgG4-RKD was made by definite cases of IgG4-RKD diagnostic criteria in 2020. Five blinded observers independently assessed image datasets by confidence scores to assess diagnostic accuracy, sensitivity, specificity, areas under the receiver operating characteristic curve (AUROC), and Cronbach's alpha coefficient.</p><p><strong>Results: </strong>A total of 31 patients were included in the study. Fourteen (45.2%) had IgG4-RKD. Five patients with IgG4-RKD had parenchymal lesions, 5 had renal pelvic lesions, and 4 had both. In the parenchymal lesions, there was no significant difference in diagnostic performance between contrast-enhanced CT and diffusion-weighted imaging (DWI)-b800. The AUROC and sensitivity were higher in DWI-b800 than in plain CT (p < 0.05). Cronbach's alpha coefficient was 0.44 for plain CT and over 0.80 for contrast-enhanced CT and DWI-b800. In the pelvic lesions, there were fewer differences in the performance among each sequence. Cronbach's alpha coefficient was over 0.80 for plain CT, contrast-enhanced CT, and DWI-b800.</p><p><strong>Conclusion: </strong>Plain MRI, especially in DWI-b800, can effectively detect renal parenchymal lesions in IgG4-RKD. In cases where the use of a contrast agent of CT is difficult, DWI-b800 can be an alternative for the screening of IgG4-RKD.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-11"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855851","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":"Advance Care Planning as Key to Person-Centered Care: A Co-Design Study Involving Adults with Chronic Kidney Disease, Family Members, and Healthcare Professionals.","authors":"Christina Egmose Frandsen, Bettina Trettin, Ingrid Villadsen Kristensen, Hanne Agerskov","doi":"10.1159/000549599","DOIUrl":"10.1159/000549599","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. Advance care planning is recommended for adults with chronic kidney disease and is an approach to facilitating person-centered care. The approach is useful at all stages of the disease and not solely related to end of life or serious disease events but also concerns management of physical, emotional, and psychological challenges throughout the illness trajectory. Living with chronic kidney disease is burdensome, and there is a need for family members to be involved in the process to support their loved ones. Therefore, this study aimed to describe a co-design, pilot test, and evaluation of an ACP intervention for adults with CKD supported by their family members. Furthermore, the article explores and critically discusses how this approach aligns with principles around person-centered care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The project was inspired by the framework of complex interventions and divided into three phases, which consisted of four sub-studies: a cross-sectional survey, an interview study, workshops for intervention development, and a qualitative evaluation of the intervention. Qualitative studies were conducted with a phenomenological-hermeneutic approach inspired by Ricoeur's interpretation theory. Quantitative data were analyzed using both descriptive and inferential statistics managed by STATA. For intervention development, co-design was applied, and data were analyzed using the action research spiral.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Living with chronic kidney disease impacted family and everyday life and led to changes in family identity and roles for both adults with chronic kidney disease and family members. There was a desire for family members to be involved in the advance care planning process to be able to support their loved ones. Healthcare professionals experienced barriers to engaging in care planning, and they had a desire for a systematic and disease-specific approach. This knowledge was used to design an advance care planning intervention in close collaboration with the consumers with a focus on person-centered care and family. The advance care planning intervention supported an open dialog about thoughts and concerns and created a shared understanding and unique knowledge.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The study provided valuable insights into the importance of supporting adults with chronic kidney disease in understanding and sharing their preferences and wishes for care and daily life and for involving family members in the ACP process to support their loved ones. Thus, an ACP intervention with a person-centered and family-focused approach was developed to improve care on an individual and family level throughout the illness trajectory. The ACP discussions were significant for adults w","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"244-256"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573446","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}