Nature Reviews Nephrology最新文献_第9页

Replenishing methionine protects the host via kidney removal of excess cytokines from blood 补充蛋氨酸可以通过肾脏清除血液中多余的细胞因子来保护宿主。

IF 39.8 1区医学

Nature Reviews Nephrology Pub Date : 2026-03-02 DOI: 10.1038/s41581-026-01064-2

Monica Wang

引用次数: 0

When access outpaces ethics: reflections on dialysis expansion and health system integrity 当获取超越道德：对透析扩展和卫生系统完整性的思考

IF 39.8 1区医学

Nature Reviews Nephrology Pub Date : 2026-02-17 DOI: 10.1038/s41581-026-01062-4

Yot Teerawattananon

引用次数: 0

Graph neural networks for computational nephrology 计算肾脏病的图神经网络

IF 39.8 1区医学

Nature Reviews Nephrology Pub Date : 2026-02-16 DOI: 10.1038/s41581-026-01059-z

Michael T. Schaub, Peter Boor

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Optimal patient care in advanced chronic kidney disease progressing to kidney failure 进展为肾衰竭的晚期慢性肾病患者的最佳护理。

IF 39.8 1区医学

Nature Reviews Nephrology Pub Date : 2026-02-10 DOI: 10.1038/s41581-026-01056-2

Christian Combe, Natalia Alencar de Pinho, Murilo Guedes, Luc Frimat, Denis Fouque, Sophie Liabeuf, Abdou Niang, Talerngsak Kanjanabuch, Bénédicte Stengel, Ziad A. Massy, Roberto Pecoits-Filho

{"title":"Optimal patient care in advanced chronic kidney disease progressing to kidney failure","authors":"Christian Combe, Natalia Alencar de Pinho, Murilo Guedes, Luc Frimat, Denis Fouque, Sophie Liabeuf, Abdou Niang, Talerngsak Kanjanabuch, Bénédicte Stengel, Ziad A. Massy, Roberto Pecoits-Filho","doi":"10.1038/s41581-026-01056-2","DOIUrl":"10.1038/s41581-026-01056-2","url":null,"abstract":"The transition from advanced chronic kidney disease (CKD) to kidney failure requires comprehensive management to optimize patient outcomes. This crucial period, in practical terms defined by CKD stages G4 and G5, involves complex decision-making regarding kidney replacement therapy, pre-emptive kidney transplantation and conservative kidney management. Patient preferences, quality of life, and comorbidities, especially cardiovascular disease, are essential considerations when making treatment decisions. Importantly, nephroprotective therapies should be continued even at advanced stages of CKD to stabilize kidney function and prevent cardiovascular events. Pre-emptive kidney transplantation, when feasible, offers the best outcomes and should be prioritized. Dialysis initiation should be based on clinical symptoms and shared decision-making with the patient, rather than laboratory values alone. For some, particularly older, patients with substantial comorbidities, conservative kidney management, emphasizing symptom management without kidney replacement therapy, might be preferred. Considerable disparities in access to care exist globally, especially in low- and middle-income countries, highlighting the need for tailored strategies. Registry and cohort studies have provided most of the scientific understanding in this area, but more randomized clinical trials are needed to guide advanced CKD management. This Review discusses key strategies for managing patients with advanced chronic kidney disease progressing towards kidney failure. The authors examine drug and lifestyle interventions that can mitigate kidney and cardiovascular risks, and options for addressing kidney failure, including transplantation, dialysis and conservative kidney care, with an emphasis on informed shared decision-making.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 6","pages":"406-421"},"PeriodicalIF":39.8,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Long-term results of pig-to-human decedent thymokidney xenotransplantation 猪到人胸腺肾异种移植的长期结果。

IF 39.8 1区医学

Nature Reviews Nephrology Pub Date : 2026-01-30 DOI: 10.1038/s41581-026-01058-0

Ellen F. Carney

引用次数: 0

CD93 and endothelial cells as therapeutic targets in podocytopathies CD93和内皮细胞作为足细胞病的治疗靶点。

IF 39.8 1区医学

Nature Reviews Nephrology Pub Date : 2026-01-29 DOI: 10.1038/s41581-026-01057-1

Monica Wang

引用次数: 0

Potassium and the kidney 钾和肾。

IF 39.8 1区医学

Nature Reviews Nephrology Pub Date : 2026-01-29 DOI: 10.1038/s41581-026-01053-5

Ewout J. Hoorn, Arohan R. Subramanya, Cary R. Boyd-Shiwarski

{"title":"Potassium and the kidney","authors":"Ewout J. Hoorn, Arohan R. Subramanya, Cary R. Boyd-Shiwarski","doi":"10.1038/s41581-026-01053-5","DOIUrl":"10.1038/s41581-026-01053-5","url":null,"abstract":"In the past decade, understanding of the mechanisms by which the kidneys sense dietary potassium imbalance and affect the cardiorenal system has substantially advanced. These mechanisms explain why low-potassium diets promote salt-sensitive hypertension, whereas potassium-rich diets enhance natriuresis and lower blood pressure. Increasing dietary potassium may therefore be an effective strategy to reduce cardiovascular disease risk. Clinical trials have shown that replacing regular salt with potassium-enriched substitutes lowers blood pressure and reduces cardiovascular events and mortality. Emerging evidence suggests that low dietary potassium intake contributes to kidney injury, and low urinary potassium excretion is associated with accelerated chronic kidney disease (CKD) progression. However, whether the cardiorenal benefits of adequate potassium intake in CKD outweigh the risk of hyperkalaemia remains uncertain. A clearer understanding of the relationship between dietary potassium intake and blood potassium levels, as well as the optimal blood potassium range for kidney and cardiovascular health, is needed to resolve this question. New strategies to mitigate hyperkalaemia, including use of potassium binders and various kidney-protective drugs, could enable people with CKD to safely consume a potassium-rich diet and avoid the need to discontinue use of medications that increase the risk of hyperkalaemia, such as renin–angiotensin–aldosterone inhibitors and mineralocorticoid receptor antagonists. In this Review, the authors discuss the physiological determinants of blood potassium levels, the health consequences of chronic hypokalaemia and hyperkalaemia, and the potential cardiorenal benefits of potassium supplementation. They also highlight strategies to reduce the risk of hyperkalaemia and enable patients with chronic kidney disease to consume a potassium-rich diet.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 5","pages":"347-362"},"PeriodicalIF":39.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mental health and kidney disease 精神健康和肾脏疾病

IF 39.8 1区医学

Nature Reviews Nephrology Pub Date : 2026-01-28 DOI: 10.1038/s41581-026-01055-3

Joseph Chilcot, Clodagh Cogley, Claire Carswell, Joanna L. Hudson, Sharlene A. Greenwood, Shivani Sharma, Kate Bramham, Andrew J. Lunn, Ken Farrington

{"title":"Mental health and kidney disease","authors":"Joseph Chilcot, Clodagh Cogley, Claire Carswell, Joanna L. Hudson, Sharlene A. Greenwood, Shivani Sharma, Kate Bramham, Andrew J. Lunn, Ken Farrington","doi":"10.1038/s41581-026-01055-3","DOIUrl":"10.1038/s41581-026-01055-3","url":null,"abstract":"Multiple long-term conditions, and particularly mental health conditions, are common in adults with chronic kidney disease (CKD). Some mental health conditions increase the risk of developing CKD, contribute to faster disease progression, and complicate care experiences and outcomes. Depression and anxiety are particularly prevalent and are associated with reduced quality of life, unplanned service use and poorer clinical outcomes. The manner in which depression and anxiety are detected and managed as part of routine kidney care can vary widely. Evidence for effective and acceptable treatments is mixed overall, although meta-analyses highlight the benefits of physical activity and cognitive behavioural therapy. Data on the use of antidepressants in people with CKD are also variable, limited by the lack of robust clinical trials. People with particularly complex needs, such as those with severe mental illness and CKD, have markedly shorter lifespans and higher rates of emergency hospitalizations than those without severe mental illness and are also less likely to access specialist nephrology care and to receive a transplantation. Health inequalities are amplified for those contending with wider disadvantages related to social and structural determinants of health. Reducing the burden of mental health in people with CKD is an urgent priority to alleviate personal and health system impacts. Here, we examine current evidence on mental health and CKD to inform policy and research and to support advances in prevention and management approaches. This Review examines the bidirectional relationship between mental health conditions, particularly depression, anxiety and severe mental illness, and chronic kidney disease. The authors discuss the impact of these comorbid conditions; provide insights and recommendations on patient management, with a focus on integrated care; and highlight key research gaps.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 5","pages":"363-376"},"PeriodicalIF":39.8,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146089563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effects of social determinants of health on the landscape of kidney disease 健康的社会决定因素对肾脏疾病的影响

IF 39.8 1区医学

Nature Reviews Nephrology Pub Date : 2026-01-23 DOI: 10.1038/s41581-026-01052-6

Luxia Zhang, Augusto Cesar S. Santos Jr, Urmila Anandh, Rajiv Saran, Ming-Hui Zhao

{"title":"Effects of social determinants of health on the landscape of kidney disease","authors":"Luxia Zhang, Augusto Cesar S. Santos Jr, Urmila Anandh, Rajiv Saran, Ming-Hui Zhao","doi":"10.1038/s41581-026-01052-6","DOIUrl":"10.1038/s41581-026-01052-6","url":null,"abstract":"Chronic kidney disease (CKD) and acute kidney injury (AKI) are highly prevalent and are associated with high morbidity and mortality. Although diabetes and hypertension are important drivers of CKD, it can result from diverse aetiologies, including autoimmune conditions, infections, genetic factors and environmental exposures. Similarly, AKI can result from diverse aetiologies. Dynamic changes within human societies and the natural environment are shaping the landscape of AKI and CKD. Urbanization, climate change, pollution and lifestyle changes are increasingly recognized for their effects on kidney health. These macro-level social determinants of health (SDH) do not affect all regions uniformly or simultaneously; rather, variations in their intensity and timing drive changes in the etiologies and epidemiology of kidney disease. Rapidly urbanizing regions in low- and middle-income countries face more challenging and complex issues from these SDHs, which are further exacerbated by inadequate healthcare infrastructures and resource constraints. An improved understanding of the influence of SDH on kidney health is crucial not only to address challenges in disease diagnosis and management but also to predict future trends across different regions. Achieving this calls for multidisciplinary strategies that integrate measures of SDH into research, policy, and healthcare models, harness digital technologies and advance equitable global collaboration. The aetiological and epidemiological landscapes of chronic kidney disease and acute kidney injury are influenced by non-medical factors, known as the social determinants of health (SDH). This Review describes how SDH shape the landscape of kidney diseases, using case studies to explore how these factors, including those associated with urbanization, can alter the aetiology and epidemiology of kidney disease.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 5","pages":"333-346"},"PeriodicalIF":39.8,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Indigenous kidney health outcomes will not improve without multilevel interventions 如果没有多层次的干预措施，本地肾脏健康状况不会得到改善

IF 39.8 1区医学

Nature Reviews Nephrology Pub Date : 2026-01-22 DOI: 10.1038/s41581-025-01046-w

引用次数: 0