Nephrology Dialysis Transplantation最新文献

{"title":"Cognitive impairment in chronic kidney disease: role of brain imaging, functional imaging, electroencephalography, cerebrospinal fluid biomarkers and sensors.","authors":"Alexandre Andrade, Maie Bachmann, Mickaël Bobot, Annette Bruchfeld, Ivo Fridolin, Laila-Yasmin Mani, Hong Xu","doi":"10.1093/ndt/gfae256","DOIUrl":"https://doi.org/10.1093/ndt/gfae256","url":null,"abstract":"<p><p>Chronic kidney disease is associated with cognitive impairment although the underlying mechanisms are still not fully understood. Characterization and efficient monitoring of the cognitive impact of kidney disease and ensuing therapies are critical for the accurate clinical management of patients. A vast array of imaging modalities, biomarkers, and sensors have shown relevance for the assessment of cognitive impairment. Knowing the potential and limitations of these paraclinical techniques is a necessary condition to improve the understanding of this phenomenon and to design monitoring protocols and guidelines applicable to this clinical population. The goal of this review is to provide an overview of current imaging modalities and biomarker sources available to the community, for the benefit of the research and clinical community.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":"40 Supplement_2","pages":"ii18-ii27"},"PeriodicalIF":4.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625254","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":"Comparison of estimated glomerular filtration rate equations on prediction of mortality, kidney failure, and acute kidney injury.","authors":"Denise M J Veltkamp, Maarten B Rookmaaker, Mark C H de Groot, Marianne C Verhaar, Wouter W van Solinge, Saskia Haitjema, Robin W M Vernooij","doi":"10.1093/ndt/gfaf054","DOIUrl":"https://doi.org/10.1093/ndt/gfaf054","url":null,"abstract":"<p><strong>Background: </strong>The CKD-EPIASR-NB2009 estimated glomerular filtration rate (eGFR) equation has shown substantial overestimation of GFR in Europeans, hence new equations have been developed. We examined the effect of introducing the European Kidney Function Consortium (EKFC) or Lund-Malmö revised (LMR) eGFR equations on KDIGO eGFR-category classification in a large cohort. We compared the EKFC and LMR equations with the CKD-EPIASR-NB2009 formula in view of discriminative ability of all-cause mortality, kidney failure with replacement therapy (KFRT), and acute kidney injury (AKI) risks across eGFR-categories.</p><p><strong>Methods: </strong>Individuals ≥18y with a SCr measurement (December 2006-July 2024) at University Medical Center Utrecht, were included. Hazard ratios (HRs) were analysed for all outcomes per eGFR-category, per equation. Harrell's Concordance index (C-index) was used to assess the ability of risk discrimination across eGFR-categories. Whether reclassification between eGFR-categories was justified by the occurrence of events, was assessed with net reclassification improvement analysis.</p><p><strong>Results: </strong>In total, 285,686 individuals were included. Compared with the CKD-EPIASR-NB2009 equation, the EKFC and LMR estimated GFR lower (mean -6.3(SD5.3) and -10.7(SD6.5)ml/min/1.732, respectively). The number of individuals with eGFR <60ml/min/1.73m2 increased 29.0%(EKFC) and 36.4%(LMR). The EKFC predominantly reclassified older individuals, and the LMR older men, to worse eGFR-categories. HRs of reclassified individuals to worse eGFR-categories were mainly higher compared with the non-reclassified. The EKFC and LMR equations showed equal/improved C-index for mortality (EKFC 0.584/LMR 0.588/CKD-EPIASR-NB2009 0.570), KFRT (0.895/0.900/0.897), and AKI (0.606/0.609/0.599). The LMR equation reclassified more individuals without an event to worse eGFR-categories.</p><p><strong>Conclusion: </strong>eGFR-category classification was substantially different when using the EKFC or LMR equation compared with the CKD-EPIASR-NB2009 formula. Both equations showed equal to improved ability of risk stratification across eGFR-categories. Shifts in eGFR-category classification might significantly impact clinical decisions. Given that we have identified variation between equations, a careful consideration of the advantages and disadvantages of different eGFR equations is essential.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605935","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":"Dietary vitamin E and tocopherol isoform intake and the progression of chronic kidney disease.","authors":"Yanjun Zhang, Ziliang Ye, Yuanyuan Zhang, Sisi Yang, Xiaoqin Gan, Yu Huang, Hao Xiang, Yiting Wu, Yiwei Zhang, Xianhui Qin","doi":"10.1093/ndt/gfaf052","DOIUrl":"https://doi.org/10.1093/ndt/gfaf052","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>It is unclear whether dietary vitamin E and tocopherol isoform intake is associated with health outcomes in patients with chronic kidney disease (CKD). We hypothesize that different dietary tocopherol isoforms have different health effects in people with CKD. Therefore, we aimed to investigate the association between dietary vitamin E and tocopherol isoforms and risks of CKD progression and all-cause mortality in patients with CKD.</p><p><strong>Methods: </strong>In this prospective cohort study, 3 791 participants with CKD in the Chronic Renal Insufficiency Cohort (CRIC) were included. The main exposures included dietary vitamin E and tocopherol isoforms, which were estimated by the validated Diet History Questionnaire at baseline, year 2, and year 4 before the study outcome was diagnosed. The primary outcome was CKD progression, defined as a 50% decline in the estimated glomerular filtration rate from baseline or initiation of kidney replacement therapy. The secondary outcome was all-cause mortality.</p><p><strong>Results: </strong>During a median follow-up of 5.5 years, 1 188 (31.3%) CKD progression events occurred. There was an L-shaped relationship between total vitamin E intake and risks of CKD progression and all-cause mortality. Regarding dietary tocopherol isoforms, there was an L-shaped relationship of dietary beta-tocopherol with risks of CKD progression and all-cause mortality, a reversed J-shaped relationship between dietary gamma-tocopherol and the risk of CKD progression and a U-shaped association between dietary delta-tocopherol and the risk of CKD progression. There was no significant association between dietary alpha-tocopherol and risks of CKD progression and all-cause mortality.</p><p><strong>Conclusions: </strong>There was an L-shaped association between total vitamin E and CKD progression in patients with CKD. Different dietary tocopherol isoforms have different relationships with CKD progression in patients with CKD, which included an L-shaped association for beta-tocopherol, a reversed J-shaped association for gamma-tocopherol, a U-shaped association for delta-tocopherol and a non-significant association for alpha-tocopherol.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575873","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":"SGLT2 Inhibitors in CKD: Are They Really Effective in All Patients?","authors":"Paola Romagnani","doi":"10.1093/ndt/gfaf051","DOIUrl":"https://doi.org/10.1093/ndt/gfaf051","url":null,"abstract":"<p><p>Sodium-glucose cotransporter-2 (SGLT2) inhibitors effectively slow chronic kidney disease (CKD) progression and reduce cardiovascular events. However, their efficacy across all CKD subgroups remains uncertain. Major clinical trials primarily included overweight or obese patients with advanced CKD, where sodium retention, volume expansion, and glomerular hyperfiltration are key disease drivers. In contrast, many underrepresented CKD subgroups, such as Alport syndrome or most immune-mediated glomerular disorders often affect lean individuals whose CKD progression is not linked to these mechanisms. Emerging evidence suggests that the renal benefits of SGLT2 inhibitors may depend on body mass index (BMI), with greater effects observed in patients with higher BMI, while those with BMI < 25 may show minimal/no benefit. This raises concerns about their applicability in lean, non-diabetic CKD patients, whose disease progression may involve alternative pathways, such as inflammation, autoimmunity, or genetic abnormalities. Animal studies further suggest that SGLT2 inhibitors provide limited renal protection in certain genetic and immune-mediated kidney diseases. Additionally, molecular data indicate that SGLT2 expression is predominantly restricted to the proximal tubule, implying a limited role in CKD driven by non-hyperfiltration mechanisms. While SGLT2 inhibitors have revolutionized CKD treatment in diabetes, obesity, and heart failure, their role in lean, non-diabetic patients remains unclear. Dedicated clinical trials are needed to assess their efficacy in underrepresented CKD subgroups and ensure evidence-based, personalized treatment strategies.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575912","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":"Very low SBP targets and the boom-and-bust cycle of benefit and adverse kidney events.","authors":"Beatriz Fernandez-Fernandez, Jose M Valdivielso, Shanmugakumar Chinnappa, Pantelis Sarafidis, Alberto Ortiz","doi":"10.1093/ndt/gfaf053","DOIUrl":"https://doi.org/10.1093/ndt/gfaf053","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575913","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":"Rationale and design of the Renal Lifecycle Trial assessing the Effect of Dapagliflozin on Cardiorenal Outcomes in Severe Chronic Kidney Disease.","authors":"Wisanne M Bakker, Hiddo J L Heerspink, Stefan P Berger, Christoph Wanner, Sunil V Badve, Clare Arnott, Alferso C Abrahams, Joost C van den Born, Tim C van Faassen, Carlo A J M Gaillard, Mariëlle A C J Gelens, Jose L Górris, Marc H Hemmelder, Lilly Jakulj, Rob C M van Kruijsdijk, Dirk R J Kuypers, Peter van der Meer, Jeroen B van der Net, Heleen H Nijmeijer, Marc G Vervloet, Aiko P J de Vries, Michael Walsh, Angela Y Wang, Ron T Gansevoort","doi":"10.1093/ndt/gfaf046","DOIUrl":"https://doi.org/10.1093/ndt/gfaf046","url":null,"abstract":"<p><strong>Background: </strong>Several clinical trials have shown beneficial effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors on kidney disease progression and cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD) with and without type 2 diabetes mellitus. However, some subgroups of patients with CKD have been excluded from participation in these trials, such as patients with severely impaired kidney function, patients on dialysis, and kidney transplant recipients.</p><p><strong>Methods: </strong>The Renal Lifecycle trial (NCT05374291) is a pragmatic, international, multicenter, investigator-initiated, randomized, placebo-controlled, clinical trial planned to enroll approximately 1500 patients with 1) an estimated glomerular filtration rate (eGFR) ≤25 ml/min/1.73m2, 2) on hemo- or peritoneal dialysis 3) a kidney transplant and an eGFR ≤45 ml/min/1.73m2, who will be randomized 1:1 to receive either dapagliflozin 10 mg once daily or matching placebo.</p><p><strong>Results: </strong>The primary endpoint is a composite of heart failure hospitalization, all-cause mortality or, for those not on dialysis, kidney failure (start of dialysis longer than 1 month, receiving a kidney transplantation or death due to kidney failure). The trial is event-driven, indicating that it will end after 468 first primary endpoint events have occurred with a power of 80% and an alpha of 0.05 to detect a 25% relative risk reduction assuming an annual 12.5% incidence of the primary outcome. The secondary endpoints include a separate analysis of the incidence of each component of the primary endpoint in the overall trial population as well as the incidence of the combined primary endpoint in each of the three subgroups of patients. Other (exploratory) endpoints are efficacy, safety, tolerability, health-related quality of life and cognition.</p><p><strong>Conclusion: </strong>The Renal Lifecycle trial aims to investigate the effects of the SGLT2 inhibitor dapagliflozin compared to placebo on the incidence of kidney failure, heart failure, mortality, and safety in three subgroups of patients with advanced CKD.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575911","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":"Real world data on dual BLyS/APRIL inhibition with telitacicept for lupus nephritis.","authors":"Jingjing Jin, Meng Tan, Ying Tan, Minghui Zhao","doi":"10.1093/ndt/gfaf049","DOIUrl":"https://doi.org/10.1093/ndt/gfaf049","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the efficacy and safety of telitacicept for the treatment of lupus nephritis (LN) in real-world clinical practice.</p><p><strong>Methods: </strong>Adult patients with lupus nephritis receiving additional telitacicept at 80/160 mg once per week were recruited, while patients receiving only standard therapy were included as the control group using a 1:1 propensity score matching approach. The primary outcomes were the proportions of patients achieving complete renal response (CRR) and primary efficacy renal response (PERR).</p><p><strong>Results: </strong>Forty-four patients in both the control and telitacicept groups were enrolled, with median follow-up periods of 10.78 ± 3.37 and 10.5 ± 3.78 months, respectively. Compared to the control group, a significant improvement was observed in the proportion of patients achieving CRR (11.36% vs. 29.55%, P = 0.034) and PERR (45.45% vs. 68.18%, P = 0.031) in the telitacicept group at the last visit. Median proteinuria was reduced by 0.97 g/d (63.82%) from baseline in the telitacicept group, compared to a reduction of 0.31 g/d (25.31%) in the control group. Additionally, the telitacicept group showed notable treatment responses in the median SLEDAI score, PGA score, and glucocorticoid dose reduction. Subgroup analysis revealed that telitacicept exhibited a more prominent therapeutic effect in patients with type V LN and those with proteinuria exceeding 3 g/d. Telitacicept was well tolerated, and the incidence of adverse events was similar between the two groups.</p><p><strong>Conclusions: </strong>Lupus nephritis patients receiving additional telitacicept treatment demonstrated better disease remission, particularly in those with type V LN and proteinuria ≥ 3 g/d, with a favorable safety profile in real-world clinical practice.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573452","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 long-term effect of tolvaptan treatment on kidney function and volume in patients with ADPKD.","authors":"Paul Geertsema, Thomas Bais, Vera Kuiken, Martine G E Knol, Niek F Casteleijn, Priya Vart, Esther Meijer, Ron T Gansevoort","doi":"10.1093/ndt/gfaf048","DOIUrl":"https://doi.org/10.1093/ndt/gfaf048","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>The only therapy to ameliorate disease progression in patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) is tolvaptan, a vasopressin V2 receptor antagonist. Real-life data on long-term tolvaptan are sparse and limited by restricted follow-up, small patient groups, or lack of a control group. We studied the long-term effect of tolvaptan on kidney function and kidney growth in real-life patients and controls. Moreover, we investigated determinants of long-term treatment efficacy.</p><p><strong>Methods: </strong>Data from the prospective DIPAK cohort and retrospective OBSERVA cohort were pooled. eGFR was measured at least yearly and total kidney volume (TKV) at least every 3 years. Treatment effects from the start to 6 weeks after initiation of tolvaptan were analyzed as 'acute slope'. After this, endpoints were analyzed as 'chronic slope'. As a control group, we included all patients who were not treated with tolvaptan, assessing change in endpoints before and during theoretical treatment (based on the average time of tolvaptan initiation in tolvaptan-treated patients).</p><p><strong>Results: </strong>615 patients (48 ± 12 years, 58.2% female) were included in the full analysis, of which 105 (17.1%) were treated with tolvaptan. The average duration of treatment was 6.1 ± 4.7 years (range: 0.8 to 15.9). After matching, two groups of 92 patients remained for matched analysis. In this analysis, tolvaptan reduced eGFR decline during chronic slope by 14.0% (-4.36 to -3.75 mL/min/1.73m2/year, P = 0.03), versus a decrease of 1.0% (-4.16 to -4.12 mL/min/1.73m2/year, P = 0.9) in the control group. Long-term TKV growth did not significantly change during tolvaptan treatment (5.05 to 5.59%/year P = 0.6). In subgroup analyses, patients with a higher mean osmolar intake had a larger treatment effect of tolvaptan.</p><p><strong>Conclusion: </strong>In this study, with real-life patient data, long-term follow-up, and a well-matched control group, we found that tolvaptan attenuated long-term kidney function decline but seemed not to influence kidney growth.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573420","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":"Celebrating the life and scientific contributions of Barry Brenner in nephrology.","authors":"Giuseppe Remuzzi","doi":"10.1093/ndt/gfae206","DOIUrl":"10.1093/ndt/gfae206","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"409-411"},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292076","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":"Biomarker-guided infliximab therapy for immune checkpoint inhibitor-induced acute interstitial nephritis.","authors":"Elena-Bianca Barbir, Arjunmohan Mohan, Priscilla Koirala, Luis E Gutierrez, Callen D Giesen, John C Lieske, Sandra M Herrmann","doi":"10.1093/ndt/gfae257","DOIUrl":"10.1093/ndt/gfae257","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"602-604"},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624548","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}