Renal Failure最新文献

{"title":"Causal impact of elevated body mass index on diabetic kidney disease: an integrated Mendelian randomization and Global Burden of Disease Study 2021 analysis.","authors":"Ye-Xin Chen, Dong-Sen Hu, Mao-Xuan Lin, Zi-Heng Gao, Han-Zhang Hong, Yu-Xin Hu, Ling-Zi Yao, Gai-Wen Cui, Lin Wang","doi":"10.1080/0886022X.2025.2472981","DOIUrl":"https://doi.org/10.1080/0886022X.2025.2472981","url":null,"abstract":"<p><strong>Background: </strong>Elevated body mass index (BMI) has been implicated in the pathogenesis of diabetic kidney disease among patients with type 2 diabetes mellitus (T2DKD). However, establishing a causal relationship and quantifying the resultant global health impact remain challenging.</p><p><strong>Methods: </strong>A two-sample Mendelian randomization (MR) analysis was conducted using summary-level data obtained from the IEU database. Multiple MR approaches, including inverse variance weighted (IVW), MR-Egger regression, weighted median, weighted mode, and simple mode methods, were implemented to ensure robust causal inference. In parallel, Global Burden of Disease Study (GBD) 2021 were analyzed to determine the trends in mortality and disability-adjusted life years (DALYs) in T2DKD attributable to high BMI (HBMI-T2DKD) from 1990 to 2021. Joinpoint regression was used to estimate the average annual percent change (AAPC). Bayesian age-period-cohort (BAPC) models were then applied to project the disease burden through 2049.</p><p><strong>Results: </strong>MR analyses provided strong evidence for a causal relationship between elevated BMI and T2DKD. The GBD analysis revealed a sustained global increase in HBMI-T2DKD burden over the past three decades. Between 1990 and 2021, the result of AAPC indicated a persistent upward trend. The burden was particularly high among older adults, with the highest impact observed in East Asia and middle Socio-Demographic Index (SDI) region. By 2049, HBMI-T2DKD-related disease burden were projected to continue rising.</p><p><strong>Conclusions: </strong>Elevated BMI is a significant causal risk factor for T2DKD. The integration of MR and GBD 2021 data underscores the urgent need for targeted public health interventions to reduce BMI levels, especially in high-risk regions and aging populations.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2472981"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of intradialytic elastic band exercise on physical and cognitive abilities in patients on maintenance hemodialysis: a randomized controlled trial.","authors":"Xianxuan Feng, Jingwen Sun, Zihan Wang, Nina Zhang, Yumei Liu, Zhenhong Wang, Niansong Wang, Guihua Jian, Dongsheng Cheng, Xiaohua Sheng, Yanhong Ma","doi":"10.1080/0886022X.2025.2482124","DOIUrl":"https://doi.org/10.1080/0886022X.2025.2482124","url":null,"abstract":"<p><p>Exercise benefits patients on maintenance hemodialysis (MHD) by addressing complications and dysfunctions. Elastic band exercise is cost-effective, but its safety, efficacy, and feasibility during dialysis are not well-established. The aim of this study is to investigate the physical and mental effects of intradialytic elastic band exercise in patients on MHD. Sixty patients on MHD were randomly assigned to the exercise or control group (30 patients/group). The control group received routine hemodialysis care, whereas those in the exercise group performed intradialytic elastic band exercises for 0.5-2 h during hemodialysis three times a week for 12 weeks. Physical function (Short Physical Performance Battery [SPPB]), cognitive function (Montreal Cognitive Assessment [MoCA]), fatigue (14-item Fatigue Scale [FS-14]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), and anxiety and depression (Hamilton Anxiety Rating Scale [HAMA]/Hamilton Depression Rating Scale [HAMD]) were assessed. The exercise group showed significant improvements in SPPB (<i>p</i> = 0.008) and MoCA (<i>p</i> < 0.001) scores compared to pre-intervention and control groups. FS-14 scores decreased significantly (<i>p</i> = 0.005). PSQI (<i>p</i> < 0.001) and HAMA (<i>p</i> < 0.001) scores improved post-intervention but not versus control. HAMD scores reduced significantly (<i>p</i> < 0.001). Satisfaction and recommendation scores were 9.57 and 9.71. In conclusions, intradialytic elastic band exercise improved physical and cognitive function and alleviated fatigue, sleep issues, depression, and anxiety in patients on MHD. With high compliance, no significant adverse events, and high patient satisfaction, it is recommended as a routine intervention during dialysis.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2482124"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prolonging calcineurin inhibitor therapy post kidney allograft failure: a prospective study.","authors":"Rita Leal, Pedro Fragoso, João Venda, José Gomes, Maria Inácio, Maria Guedes Marques, Luís Rodrigues, Lídia Santos, Catarina Romãozinho, Francisco Caramelo, Helena Oliveira Sá, António Martinho, Arnaldo Figueiredo, Rui Alves","doi":"10.1080/0886022X.2025.2483386","DOIUrl":"10.1080/0886022X.2025.2483386","url":null,"abstract":"<p><strong>Background: </strong>The optimal immunosuppressive (IS) withdrawal strategy after kidney allograft failure remains unclear. This study evaluated the effects of prolonged calcineurin inhibitor (CNI) therapy on HLA sensitization, graft intolerance syndrome (GIS), and key clinical outcomes.</p><p><strong>Methods: </strong>We conducted a prospective cohort study involving 90 adult patients with kidney allograft failure who were candidates for re-transplantation. Patients were divided into two groups: Rapid withdrawal group (discontinuation of all IS except low-dose prednisolone) and Prolonged CNI Group (maintenance of CNI for six months plus low-dose prednisolone). Outcomes assessed over a 12-month follow-up period included HLA sensitization, defined as an increase in calculated panel reactive antibody (cPRA) and the development of de novo donor-specific antibodies (dnDSA), GIS incidence, re-transplantation, hospitalization rates, and mortality.</p><p><strong>Results: </strong>No significant differences were observed between the groups regarding HLA sensitization one-year postgraft failure. A composite outcome of cPRA increase, dnDSA, and GIS did not differ between the groups. When evaluated separately, GIS occurred less frequently in the Prolonged CNI Group (4.8% vs. 23%; <i>p</i> = 0.015). Patients who continued CNI maintained better residual kidney function at 6 months (800 vs. 200 mL, <i>p</i> = 0.001) and experienced lower all-cause hospitalization rates (12% vs. 30%, <i>p</i> = 0.036), with comparable retransplantation and mortality rates. Graft removal and higher HLA mismatches were independently linked to increased sensitization at 12 months.</p><p><strong>Conclusions: </strong>Prolonged CNI therapy for six months postallograft loss did not prevent HLA sensitization but reduced the incidence of GIS and preserved residual kidney function without increasing hospitalization or mortality.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2483386"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dapagliflozin improves diabetic kidney disease by inhibiting ferroptosis through β-hydroxybutyrate production.","authors":"Yan Tian, Chenxia Zhou, Qun Yan, Ziyi Li, Da Chen, Bo Feng, Jun Song","doi":"10.1080/0886022X.2024.2438857","DOIUrl":"https://doi.org/10.1080/0886022X.2024.2438857","url":null,"abstract":"<p><strong>Background: </strong>Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease. Sodium-glucose cotransporter protein 2 inhibitors (SGLT2i) are antihyperglycemic agents that provide additional renal-protective effects in patients with DKD, independent of their glucose-lowering effects. However, the underlying mechanism remains unclear. This study hypothesized that SGLT2i could alleviate diabetic kidney injury by inhibiting ferroptosis and explored its potential mechanisms.</p><p><strong>Methods: </strong>C57BL/6J mice were randomly divided into the control, DKD, DKD+dapagliflozin, and DKD+insulin treatment groups. Blood glucose levels and body weight were monitored. Renal function, tissue pathology, mitochondrial morphology and function, and lipid peroxidation biomarkers (lipid peroxidation [LPO], malondialdehyde [MDA], glutathione peroxidase 4 [GPX4], glutathione [GSH], and cystine transporter solute carrier family 7 member 11 [SLC7A11]) were evaluated. Human proximal tubule cells (HK2 cells) were exposed to high glucose alone or in combination with dapagliflozin. The mitochondrial membrane potential (MMP), adenosine triphosphate (ATP) level, NAD+/NADH ratio (oxidized/reduced ratio of nicotinamide adenine dinucleotide), and lipid peroxidation were measured. In addition, the role of the β-hydroxybutyrate- Calcium/Calmodulin Dependent Protein Kinase Kinase 2 (BHB-CaMKK2) axis in mediating dapagliflozin regulating ferroptosis was examined.</p><p><strong>Results: </strong>Dapagliflozin significantly ameliorated kidney injury in mice with DKD. Typical changes in ferroptosis, including lipid peroxidation and impaired antioxidant capacity, increased in mice with DKD and HG-treated HK-2 cells. Dapagliflozin significantly improves ferroptosis-related lipid peroxidation and mitochondrial dysfunction. Furthermore, dapagliflozin suppressed the expression of CaMKK2, a key ferroptosis regulator. Specific CaMKK2 inhibitors alleviated mitochondrial damage and ferroptosis, whereas a CaMKK2 agonist counteracted the protective effects of dapagliflozin against mitochondrial, antioxidant, and anti-ferroptosis effects. In addition, dapagliflozin increased BHB production, which mediates its nephroprotective effects.</p><p><strong>Conclusion: </strong>Dapagliflozin improves DKD by inhibiting ferroptosis, promoting BHB production, and regulating CaMKK2.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2438857"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges encountered to creating a renal biopsy program at a tertiary care academic institution in the United States.","authors":"Eily Hayes, Erik Mai, Andre Uflacker, Natalie Freidin","doi":"10.1080/0886022X.2024.2449576","DOIUrl":"10.1080/0886022X.2024.2449576","url":null,"abstract":"<p><p>Biopsy is the gold standard for diagnosing renal pathology and the procedure is required to be learned per ACGME guidelines for Nephrology Fellowship graduation. We describe the process for the planning and development of a new Nephrologist directed native renal biopsy program to increase the opportunity to train Nephrology fellows in this procedure. The article outlines the barriers, complications and lessons learned to developing the program, highlighting the key challenges and progress that has been made within a single American tertiary academic medical center.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2449576"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of the triglyceride-glucose index on the deterioration of kidney function in patients with cardiovascular-kidney-metabolic syndrome: insight from a large cohort study in China.","authors":"Zhi Shang, Song-Tao Feng, Hui Qian, Zhen-Ling Deng, Yue Wang, Yue-Ming Gao","doi":"10.1080/0886022X.2024.2446656","DOIUrl":"10.1080/0886022X.2024.2446656","url":null,"abstract":"<p><strong>Background: </strong>The triglyceride-glucose (TyG) index has emerged as a credible surrogate indicator of insulin resistance in recent years. This study aimed to investigate the relationship between the TyG index and the deterioration of kidney function in patients with cardiovascular-kidney-metabolic (CKM) syndrome.</p><p><strong>Methods: </strong>In this retrospective cohort study from China, 27,407 hospitalized patients with stage 1-4 CKM syndrome were consecutively included. The participants were categorized into four groups according to TyG index quartiles. The study outcome was the deterioration of kidney function, defined as a decrease in estimated glomerular filtration rate (eGFR) ≥ 40% from baseline. Restricted cubic spline (RCS) curves and multivariate Cox analysis were used for analysis.</p><p><strong>Results: </strong>3,248 outcome events were recorded during a mean follow-up period of 34 months. The RCS plot displayed a U-shaped curve between the baseline TyG index and the deterioration of kidney function (<i>P</i> for non-linear < 0.001). The baseline TyG index with the lowest hazard ratio (HR) of eGFR decline ranges from 8.65 to 9.15, with an inflection point at 8.88. After fully adjusting for covariates, HRs and 95% confidence intervals (CIs) from the lowest to highest TyG index quartile were 1.00 (reference), 0.82 (0.74, 0.91), 0.78 (0.70, 0.86), and 0.93 (0.83, 1.03), respectively. According to the Kaplan-Meier survival curve, the risk of deterioration of kidney function was elevated in the lowest and highest TyG index quartiles (log-rank test, <i>p <</i> 0.0001).</p><p><strong>Conclusions: </strong>In individuals with CKM syndrome, a non-linear U-shaped relationship existed between the baseline TyG index and the deterioration of kidney function.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2446656"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of tea consumption with all-cause/cardiovascular disease mortality in the chronic kidney disease population: an assessment of participation in the national cohort.","authors":"Jin Li, Xing-Ling Chen, Xiao-Lu Ou-Yang, Xiao-Jiao Zhang, Yue Li, Shu-Ning Sun, Ling-Jun Wang, Zhong-Qi Yang, Shi-Hao Ni, Lu Lu","doi":"10.1080/0886022X.2025.2449578","DOIUrl":"10.1080/0886022X.2025.2449578","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;While there are numerous benefits to tea consumption, its long-term impact on patients with chronic kidney disease (CKD) remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;Our analysis included 17,575 individuals with CKD from an initial 45,019 participants in the National Health and Nutrition Examination Survey (NHANES) (1999-2018). Individuals with extreme dietary habits, pregnancy, or non-CKD conditions were excluded. Key cohort demographics revealed a mean age of 62.3 years, with 52.1% female participants, and 57.3% identified as non-Hispanic White. A total of 5,835 deaths were recorded during follow-up, including 1,823 cardiovascular-related deaths. Cox and restricted cubic spline regression was used to examine the linear or nonlinear association of tea consumption with mortality. The substitution analysis explored the effects of replacing a specific type of tea with another type of tea. Subgroup analysis stratified by sex, age, body mass index (BMI), diabetes, cancer, cardiovascular disease (CVD), and urinary albumin. Sensitivity analysis was performed to ensure the reliability of our findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;After adjusting for age, sex, race, education level, marital, annual household income, energy intake, total water intake, protein intake, carbohydrate intake, dietary fiber, sugar beverages, milk whole, total monounsaturated fatty acids, total polyunsaturated fatty acids, total saturated fatty acids, smoking, metabolic equivalent of task for physical activity level (MET-PA), BMI, diabetes, hypertension, urinary albumin, estimated glomerular filtration rate (eGFR), CVD, cancer, serum sodium, serum potassium, and serum phosphorus, setting the individuals without tea consumption record as reference. Consuming up to 4 cups of tea per day was significantly associated with lower all-cause mortality compared with that never drinking tea, among CKD patients at 1-2 stages [Hazard Ratio (HR) = 0.89; 95% Confidence Interval (CI) = 0.79, 0.99; &lt;i&gt;p&lt;/i&gt; = 0.04], while the association between tea consumption and CVD mortality didn't reach statistical significance. Dose-response effect was observed, showing that consuming up to three to five cups of tea per day was associated with mitigated risks of all-cause mortality, particularly in early CKD stages (non-linear &lt;i&gt;p&lt;/i&gt; &gt; 0.05). A 1 cup per day higher intake of oxidized tea was associated with a 10% lower risk of all-cause mortality in CKD stage 1-2 [HR = 0.90; 95%CI = 0.82, 0.99; &lt;i&gt;p&lt;/i&gt; = 0.03]. Replacing 1 cup of green tea with 1 cup of oxidized tea per day was associated with an 8% and 11% lower risk of all-cause mortality [HR = 0.92; 95%CI = 0.86, 0.98; &lt;i&gt;p&lt;/i&gt; = 0.01] and CVD mortality [HR = 0.89; 95%CI = 0.80, 1.00; &lt;i&gt;p&lt;/i&gt; &lt; 0.05], respectively, in individuals with CKD stages 1-2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Tea consumption showed protective effects on all-cause mortality in CKD population, with potential benefits observed in terms of","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2449578"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of low donor-to-recipient body weight ratio on graft survival after dual kidney transplantation from pediatric deceased donors.","authors":"Mingchuan Huang, Shenghui Wu, Pengfei Gao, Li Zhou, Qian Fu, Chenglin Wu, Huanxi Zhang, Yitao Zheng, Xiaojun Su, Wenrui Wu, Jinghong Tan, Qiang Zhang, Pei Xia, Zhe Xu, Longshan Liu, Jun Li, Changxi Wang","doi":"10.1080/0886022X.2025.2454968","DOIUrl":"10.1080/0886022X.2025.2454968","url":null,"abstract":"<p><strong>Background: </strong>Dual kidney transplantation (DKT) from small pediatric donors, either en-bloc or split dual kidney transplantation, contributes to mitigating organ scarcity. This study investigates the prognosis of DKT from pediatric deceased donors, and influencing factors.</p><p><strong>Method: </strong>A retrospective study included recipients who underwent DKT from pediatric donors between 2012 and 2022. Recipients were categorized into low mismatch (BWLM, <i>n</i> = 30) and high mismatch (BWHM, <i>n</i> = 10) groups based on donor-recipient weight ratio of 1:10. Outcome encompassed recipient and graft survival, renal function, and adverse events.</p><p><strong>Result: </strong>Forty recipients were included. The average follow-up period was 54.6 months. The 1, 3, and 5-year patient survival were 97.4%, with no significant differences between en-bloc and split dual kidney transplantation or between BWLM and BWHM groups. The graft survival at 1, 3, and 5 years were 89.9%, the graft survival of BWHM group was lower than BWLM group (70% vs 96.7%, <i>p</i> = 0.039). The average eGFR at 1, 3, and 5 years postoperatively were (78.93 ± 25.23), (83.82 ± 32.4), and (85.92 ± 37.08) mL/min/1.73 m², respectively. The BWHM group also experienced higher rates of graft-related surgical complications (<i>p</i> = 0.006) and urinary tract surgical complications (<i>p</i> = 0.042).</p><p><strong>Conclusion: </strong>DKT from pediatric donors yields favorable outcomes, with similar graft survival and complication rates across surgical subgroups. However, significant donor-recipient weight mismatch, particularly when the ratio is less than 1:10, may contribute to increased surgical complications and poorer graft survival. Efforts to minimize extreme weight mismatch are recommended to optimize outcomes.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2454968"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep learning for the prediction of acute kidney injury after coronary angiography and intervention in patients with chronic kidney disease: a model development and validation study.","authors":"Ying Tang, Ting Wu, Xiufen Wang, Xi Wu, Anqun Chen, Guochun Chen, Chengyuan Tang, Liyu He, Yuting Liu, Meiyu Zeng, Xiaoqin Luo, Shaobin Duan","doi":"10.1080/0886022X.2025.2474206","DOIUrl":"10.1080/0886022X.2025.2474206","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic kidney disease (CKD) are considered the primary population at risk for post-contrast acute kidney injury (PC-AKI), yet there are few predictive tools specifically designed for this vulnerable population.</p><p><strong>Methods: </strong>Adult CKD patients undergoing coronary angiography or percutaneous coronary intervention at the Second Xiangya Hospital (2015-2021) were enrolled. The patients were divided into a derivation cohort and a validation cohort based on their admission dates. The primary outcome was the development of PC-AKI. The random forest algorithm was used to identify the most influential predictors of PC-AKI. Six machine learning algorithms were used to construct predictive models for PC-AKI. Model 1 included only preoperative variables, whereas Model 2 included both preoperative and intraoperative variables. The Mehran score was included in the comparison as a classic postoperative predictive model for PC-AKI.</p><p><strong>Results: </strong>Among the 989 CKD patients enrolled, 125 (12.6%) developed PC-AKI. In the validation cohort, deep neural network (DNN) outperformed other machine learning models with the area under the receiver operating characteristic curve (AUROC) of 0.733 (95% CI 0.654-0.812) for Model 1 and 0.770 (95% CI 0.695-0.845) for Model 2. Furthermore, Model 2 showed better performance compared to the Mehran score (AUROC 0.631, 95% CI 0.538-0.724). The SHapley Additive exPlanations method provided interpretability for the DNN models. A web-based tool was established to help clinicians stratify the risk of PC-AKI (https://xydsbakigroup.streamlit.app/).</p><p><strong>Conclusion: </strong>The explainable DNN models serve as promising tools for predicting PC-AKI in CKD patients undergoing coronary angiography and intervention, which is crucial for risk stratification and clinical descion-making.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2474206"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and potential pharmacological mechanism of <i>Astragalus-Salvia miltiorrhiza</i> combination in diabetic nephropathy: integrating meta-analysis, network pharmacology, molecular docking, and experimental validation.","authors":"Huiyu Liang, Zedong Chen, Mingmin Zhu, Jingying Zhong, Shufan Lin, Jianfeng Chen, Jing Yuan, Pingping Jiang, Xiaoshan Zhao, Ya Xiao","doi":"10.1080/0886022X.2025.2466116","DOIUrl":"10.1080/0886022X.2025.2466116","url":null,"abstract":"<p><strong>Background: </strong>Diabetic nephropathy (DN) is a diabetes mellitus (DM)-induced complication that poses high morbidity and mortality risks. The <i>Astragalus</i> and <i>Salvia miltiorrhiza</i> couplet medicines (AS) are commonly employed in DN clinical treatment in China, but their clinical efficacy and potential pharmacological mechanisms are yet to be evaluated.</p><p><strong>Material and methods: </strong>A meta-analysis of 15 studies involving 1,443 patients was conducted. Furthermore, network pharmacology predicted components and targets, which were verified by molecular docking and <i>in vivo</i> validation.</p><p><strong>Results: </strong>In our meta-analysis, AS notably elevated clinical outcomes and renal function among patients with DN. Meanwhile, when the treatment duration exceeds 12 weeks, AS demonstrated a significant reduction in fasting blood glucose levels, indicating a time-dependent effect. Moreover, based on network pharmacology results, AS likely enhanced clinical outcomes by interacting with vital signaling pathways, including PI3K/Akt, MAPK, and NF-kappa B. Molecular docking studies have confirmed that PTGS2, the key therapeutic target of AS, can be closely combined with bioactive components <i>GLY</i>, <i>quercetin</i>, <i>apigenin,</i> and <i>daidzein</i>. Additionally, <i>in vivo</i> experiments have corroborated that AS can ameliorate renal function, UACR, and biomarkers associated with iron metabolism, such as GPX4, PTGS2, FTH1, and FTL1.</p><p><strong>Conclusion: </strong>Through rigorous experimental validation, our study demonstrates AS's significant clinical efficacy in managing DN. Specifically, AS has been shown to enhance renal function, ameliorate renal fibrosis, and positively influence iron metabolism. Despite these promising outcomes, future research with a larger sample size must be conducted to further substantiate these findings.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2466116"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}