Nephrology Dialysis Transplantation最新文献

{"title":"Exploring the metaverse: opportunities for nephrology in patient care and education.","authors":"Carmine Zoccali, Francesca Mallamaci","doi":"10.1093/ndt/gfae281","DOIUrl":"10.1093/ndt/gfae281","url":null,"abstract":"<p><p>The metaverse, a digital ecosystem characterized by the convergence of physical and virtual realities through technologies like virtual reality (VR), augmented reality (AR) and mixed reality, is reshaping societal and economic landscapes. In healthcare, the metaverse promises to revolutionize service delivery and medical education by overcoming geographical barriers and democratizing access to information. However, challenges such as the digital divide and privacy concerns persist. Economically, the metaverse is projected to significantly boost global GDP, with healthcare sectors poised for substantial growth through innovations like virtual clinics and telemedicine. In nephrology, the metaverse offers new avenues for patient education, treatment planning, and collaborative research. The integration of VR and AR technologies can enhance patient engagement by providing interactive platforms for understanding their condition, treatment options and lifestyle modifications. This approach empowers patients to take an active role in managing their health, potentially improving adherence to treatment regimens and overall outcomes. Furthermore, VR applications in hemodialysis have shown promise in reducing treatment-related symptoms and improving psychological well-being. The development of virtual clinics for chronic kidney disease patients could facilitate remote monitoring and management, reducing the need for emergency dialysis and improving long-term patient outcomes. Despite the burgeoning interest and research in this field, the integration of VR and AR into routine clinical practice remains in its nascent stages. The potential of these technologies to enhance patient care, improve surgical precision and provide immersive educational experiences is immense, paving the way for a future where technology and medicine are intricately linked.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"865-873"},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739568","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":"Noncanonical microglial IL-1β maturation in chronic kidney disease.","authors":"Silke Zimmermann, Akash Mathew, Olga Bondareva, Ahmed Elwakiel, Shihai Jiang, Rajiv Rana, Ingo Bechmann, Jürgen Goldschmidt, Nora Klöting, Bilal N Sheikh, Berend Isermann","doi":"10.1093/ndt/gfae239","DOIUrl":"10.1093/ndt/gfae239","url":null,"abstract":"<p><strong>Background: </strong>Organ transplantation reverses cognitive impairment in chronic kidney disease (CKD), indicating that cognitive impairment driven by CKD is therapeutically amendable. We recently demonstrated that impaired cognition in CKD is linked to interleukin-1β (IL-1β) release from microglia and IL-1 receptor type 1 signalling in neuronal cells, thereby identifying a signalling pathway that can be exploited therapeutically. However, the mechanism of IL-1β maturation in microglia in CKD remains unknown. We hypothesized that microglia cells require caspase-1 for CKD-driven cognitive impairment.</p><p><strong>Methods: </strong>We used a combination of single-cell analyses, in situ analyses, genetically modified mouse models (including newly generated Cre-LoxP mouse models) and in vitro models. The current study builds on a recently identified intercellular cross-talk between microglia and neurons that impairs cognition in CKD.</p><p><strong>Results: </strong>Here we show that despite NLRP3 inflammasome activation in the brain and protection of mice with constitutive NLRP3 deficiency from CKD-induced cognitive impairment, caspase-1 is not required for IL-1β maturation in microglia and targeted caspase-1 deficiency in microglia does not improve cognition in CKD mice. These data indicate that IL-1β maturation in microglia is independent of the NLRP3-caspase-1 interaction in CKD. Indeed, microglia activation in CKD induces noncanonical, cathepsin C-caspase-8-mediated IL-1β maturation. Depletion of cathepsin C or caspase-8 blocks IL-1β maturation in microglia. Preliminary analyses suggest that noncanonical microglia IL-1β maturation occurs also in diabetes mellitus.</p><p><strong>Conclusion: </strong>These results identify a noncanonical IL-1β-maturation pathway as a potential therapeutic target to combat microglia-induced neuronal dysfunction in CKD and possibly other peripheral diseases.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"929-942"},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576546","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":"Effect of pharmacist interventions in chronic kidney disease: a meta-analysis.","authors":"Ashkon Ardavani, Ffion Curtis, Ellen Hopwood, Patrick Highton, Priscilla Katapa, Kamlesh Khunti, Thomas J Wilkinson","doi":"10.1093/ndt/gfae221","DOIUrl":"10.1093/ndt/gfae221","url":null,"abstract":"<p><strong>Background: </strong>Pharmacists are uniquely placed with their therapeutic knowledge to manage people with chronic kidney disease (CKD). Data are limited regarding the impact of pharmacist interventions on economic, clinical and humanistic outcomes (ECHO).</p><p><strong>Methods: </strong>A systematic review and meta-analysis of randomized controlled trials (RCTs) of interventions with pharmacist input was conducted, which included adults with a diagnosis of CKD, including those with and without kidney replacement therapy. Data were extracted on ECHO: economic (e.g. healthcare-associated costs), clinical (e.g. mortality) and humanistic (e.g. patient satisfaction) outcomes. Where appropriate, a random-effects model meta-analysis generated a pooled estimate of effect. A direction of effect plot was used to summarize the overall effects for clinical outcome domains.</p><p><strong>Results: </strong>Thirty-two RCTs reported a total of 10 economic, 211 clinical and 18 humanistic outcomes. Pharmacist interventions resulted in statistically significant improvements in systolic blood pressure and hemoglobin levels, but not in diastolic blood pressure, estimated glomerular filtration rate, creatinine and low-density lipoprotein cholesterol levels. Mixed findings were reported for clinical and economic outcomes, whilst pharmacist interventions resulted in an improvement in humanistic outcomes such as patient satisfaction and patient knowledge.</p><p><strong>Conclusion: </strong>Findings showed pharmacist interventions had mixed results for various outcomes. Future studies should be more robustly designed and take into consideration the role of the pharmacist in prescribing and deprescribing, the findings of which will help inform research and clinical practice.</p><p><strong>Trial registration: </strong>The review was prospectively registered on PROSPERO (CRD42022304902).</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"884-907"},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392031","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":"Hyperkalemia and maintenance of renin-angiotensin system inhibitor therapy after initiating SGLT-2 or DPP-4 inhibitors.","authors":"Alessandro Bosi, Yang Xu, Anne-Laure Faucon, Tao Huang, Marie Evans, Jung-Im Shin, Edouard L Fu, Juan Jesus Carrero","doi":"10.1093/ndt/gfae227","DOIUrl":"10.1093/ndt/gfae227","url":null,"abstract":"<p><strong>Background: </strong>Post hoc analyses of clinical trials suggest that sodium-glucose cotransporter-2 inhibitors (SGLT-2i) lower the risk of hyperkalemia and facilitate the use of renin-angiotensin system inhibitors (RASi) in people with type 2 diabetes. Whether this is also observed in routine care is unclear. We investigated whether SGLT-2i lowered the risk of hyperkalemia and RASi discontinuation as compared to dipeptidyl peptidase 4 inhibitors (DPP-4i).</p><p><strong>Methods: </strong>Using the target trial emulation framework, we studied adults with type 2 diabetes (T2D) who started SGLT-2i or DPP-4i in Stockholm, Sweden (2014-2021). The outcomes were incident hyperkalemia (potassium >5.0 mmol/l), mild hyperkalemia (potassium >5-≤5.5 mmol/l), and moderate to severe hyperkalemia (potassium >5.5 mmol/l). Among RASi users, we studied time to RASi discontinuation through evaluation of pharmacy fills. Cox regression with inverse probability of treatment weighting was used to estimate per-protocol hazard ratios (HRs).</p><p><strong>Results: </strong>In total, 29 849 individuals (15 326 SGLT-2i and 14 523 DPP-4i initiators) were included (mean age 66 years, 37% women). About one-third of participants in each arm discontinued treatment within 1 year. Compared with DPP-4i, SGLT-2i use was associated with a lower rate of hyperkalemia (HR 0.77; 95% CI: 0.64-0.93), including both mild (0.76; 0.62-0.93) and moderate/severe (0.53; 0.40-0.69) hyperkalemia events. Of 19 116 participants who used RASi at baseline, 7% discontinued therapy. Initiation of SGLT-2i vs. DPP-4i was not associated with the rate of RASi discontinuation (0.97; 0.83-1.14). Results were consistent in intention-to-treat analysis and across strata of sex, cardiovascular disease, use of MRA, and use of RASi.</p><p><strong>Conclusions: </strong>In patients with diabetes managed in routine clinical care, the use of SGLT-2i was associated with lower rates of hyperkalemia compared with DPP-4i. Possibly because of a relatively high rate of treatment discontinuations, this was not accompanied by higher persistence on RASi therapy.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"956-966"},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NINJ1-mediated macrophage plasma membrane rupture and neutrophil extracellular trap formation contribute to oxalate nephropathy.","authors":"Yujiao Lin, Ying Yuan, Keng Ye, Zhimin Chen, Yujia Wang, Guoping Li, Yankun Song, Hong Chen, Huabin Ma, Yanfang Xu","doi":"10.1093/ndt/gfae226","DOIUrl":"10.1093/ndt/gfae226","url":null,"abstract":"<p><strong>Background: </strong>Oxalate nephropathy is characterized by calcium oxalate crystals deposition, which triggers necrosis of renal tubular epithelial cells and initiates an inflammatory cascade characterized by neutrophil and macrophage activation within the renal microenvironment. Despite the close association of immune cells with acute oxalate nephropathy, the underlying mechanisms still remain unclear. Nerve injury-induced protein 1 (NINJ1) plays an essential role in the induction of plasma membrane rupture (PMR), leading to damage-associated molecular patterns (DAMPs) release and triggering inflammation. We hypothesize that NINJ1-mediated high mobility group box 1 (HMGB1) release from macrophage PMR and neutrophil extracellular traps (NETs) formation synergistically contribute to the progression of acute oxalate nephropathy.</p><p><strong>Methods: </strong>Using a murine model of acute oxalate nephropathy, myeloid cell-specific deletion of Ninj1 mice (Ninj1fl/flvavcre) and their wild-type littermate control mice (Ninj1wt/wtvavcre) were administered intraperitoneal injection of 100 mg/kg sodium oxalate followed by drinking water with 3% sodium oxalate. Evaluation was conducted on tubular injury and inflammatory cell infiltration. In vitro studies involved isolation and culture of renal proximal tubular epithelial cells, bone marrow-derived macrophages and neutrophils to investigate NETs formation and HMGB1 release.</p><p><strong>Results: </strong>Targeted deletion of Ninj1 in myeloid cells significantly mitigated oxalate-induced acute kidney injury by suppressing both HMGB1 release and NETs formation in vivo. In vitro investigations demonstrated that HMGB1 release from macrophage PMR and NETs formation in neutrophils mediated by NINJ1 oligomerization, which consequently coordinated to enhance renal tubular epithelial cell death.</p><p><strong>Conclusions: </strong>Our findings elucidate the pivotal role of NINJ1-dependent macrophage PMR and NETs formation in the progression of acute oxalate nephropathy, providing novel insights for its prevention and therapeutic targets.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"943-955"},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392034","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 use of lung ultrasound monitoring and the risk of intradialysis hypotension in hemodialysis patients: an analysis in the context of a randomized clinical trial.","authors":"Claudia Torino, Francesca Mallamaci, Rocco Tripepi, Sabrina Mezzatesta, Giovanni Tripepi, Carmine Zoccali","doi":"10.1093/ndt/gfaf015","DOIUrl":"10.1093/ndt/gfaf015","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1059-1061"},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053030","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-time monitoring of postfilter calcium in regional citrate anticoagulation for continuous renal replacement therapy.","authors":"Zhang Qi, Zhang Beiyi, Yue Zengqi, Sun Chen, Yu Jin, Ding Feng","doi":"10.1093/ndt/gfaf006","DOIUrl":"10.1093/ndt/gfaf006","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1055-1058"},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979316","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":"Stenosis of the glomerulotubular neck in progressive chronic kidney disease.","authors":"Eric P Cohen, Aleksandar Denic, Fnu Aperna, Aidan F Mullan, Laura Barisoni, Vidit Sharma, Ian W Gibson, Andrew D Rule","doi":"10.1093/ndt/gfae234","DOIUrl":"10.1093/ndt/gfae234","url":null,"abstract":"<p><strong>Background: </strong>Morphology and morphometric evaluation of lesions beyond conventional parameters can inform the pathophysiology of chronic kidney disease (CKD). We sought to determine whether the occurrence of glomerulotubular neck stenoses associates with progressive CKD.</p><p><strong>Methods: </strong>We evaluated the normal parenchyma from radical nephrectomies removed for tumor between 2000 and 2021 and analyzed cortex for stenoses of the glomerulotubular neck. Stenosis of the glomerulotubular neck is defined a focal narrowing for which the draining tubule has a greater diameter than at the neck. Progressive CKD was defined as dialysis, kidney transplantation, sustained estimated glomerular filtration rate (eGFR) <10 mL/min/1.73 m2 or sustained 40% decline from the post-nephrectomy eGFR. Each case of progressive CKD was age- and sex-matched to two controls without progressive CKD. Logistic regression models assessed the risk of progressive CKD with stenotic necks adjusting for other histological features, kidney function and CKD risk factors.</p><p><strong>Results: </strong>There were 65 cases with a mean of 255 glomeruli and 130 controls with a mean of 329 glomeruli. Among both cases and controls, 5% of glomeruli showed visible glomerulotubular necks. The proportion of necks that were stenotic was higher in cases than controls (35% vs 11%, P < .0001). Stenotic necks associated with progressive CKD independent of other histologic and clinical characteristics.</p><p><strong>Conclusion: </strong>Glomerulotubular neck stenosis is associated with development of progressive CKD.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"917-928"},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470747","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":"Acquired and genetic determinants of disease phenotype and therapeutic strategies in C3 glomerulopathy and immunoglobulin-associated MPGN.","authors":"Marie-Sophie Meuleman, Julia Roquigny, Romain Brousse, Carine El Sissy, Guillaume Durieux, Moglie Le Quintrec, Jean-Paul Duong Van Huyen, Véronique Frémeaux-Bacchi, Sophie Chauvet","doi":"10.1093/ndt/gfae245","DOIUrl":"10.1093/ndt/gfae245","url":null,"abstract":"<p><p>C3 glomerulopathy (C3G), a prototype of complement-mediated disease, is characterized by significant heterogeneity, in terms of not only clinical, histological and biological presentation but also prognosis, and response to existing therapies. Recent advancements in understanding the factors responsible for alternative pathway dysregulation in the disease have highlighted its even more complex nature. Here, we propose a reexamination of the diversity of C3G presentations in light of the drivers of complement activation. Autoantibodies targeting complement proteins, genetic abnormalities in complement genes and monoclonal immunoglobulins are now well-known to drive disease occurrence. This review discusses how these drivers contribute to the heterogeneity in disease phenotype and outcomes, providing insights into tailored diagnostic and therapeutic approaches. In recent years, a broad spectrum of complement inhibitory therapies has emerged, soon to be available in clinical practice. The recognition of specific clinical, biological and histological patterns associated with different forms of C3G is crucial for personalized management, particularly treatment strategies.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"842-851"},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624522","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":"Self-reported Non-adherence to Immunosuppressive Medication Detected by the BAASIS Predicts Allograft Rejections in Kidney Transplant Recipients.","authors":"Frederik Haupenthal, Konstantin Doberer, Sebastian Kapps, Johannes Kläger, Florian Bauernfeind, Kris Denhaerynck, Alexander Kainz, Sabina De Geest, Gregor Bond","doi":"10.1093/ndt/gfaf078","DOIUrl":"https://doi.org/10.1093/ndt/gfaf078","url":null,"abstract":"<p><strong>Background: </strong>After kidney transplantation adherence to immunosuppressive medication is crucial for graft survival and its assessment requires valid measurements. The Basel-Assessment-of-Adherence-to-Immunosuppressive-Medications-Scale (BAASIS) is a validated self-report tool to detect non-adherence, however its ability to predict clinically relevant outcomes remains to be established.</p><p><strong>Methods: </strong>In this prospective cohort study including 226 consecutive kidney graft recipients transplanted at the Medical University of Vienna between 2018 and 2019 the adherence towards immunosuppressive medication was monitored for 2 years after transplantation. The BAASIS was applied at the first outpatient visit and at months 3, 6, 9, 12, and 24 post-transplant to assess the implementation and persistence phase of adherence. Non-adherence was defined by any positive response to one of the BAASIS-items. The primary endpoint was biopsy-proven allograft rejection defined by the BANFF meeting report during a maximum follow-up of 4 years.</p><p><strong>Results: </strong>Of the total study cohort (median age 56 years [IQR 46-63], 75 [33%] female), 125 recipients (55%) reported non-adherence at least once. Self-reported non-adherence increased within the first three months from 11% to 31% and remained between 27% and 32% at month 6 to 24 post-transplant. Non-adherent recipients experienced more allograft rejections than adherent patients (24%, n=30 vs. 7%, n = 7; P < 0.001) during a median follow-up of 3.7 years (IQR 1.0-4.0). Using a time-dependent Cox regression model, the adjusted hazard ratio for allograft rejection associated with previously reported non-adherence was 2.90 (95% CI 1.51-5.58; P = 0.001) accounting for recipient sex, age at transplantation and history of previous transplantation.</p><p><strong>Conclusion: </strong>Our findings support the clinical value of the BAASIS. Its implementation into routine post-transplant care may facilitate the identification of clinically relevant medication non-adherence, enabling timely interventions.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030009","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}