Renal Failure最新文献

{"title":"Retraction: Hirudin ameliorates immunoglobulin a nephropathy by inhibition of fibrosis and inflammatory response.","authors":"","doi":"10.1080/0886022X.2025.2462380","DOIUrl":"10.1080/0886022X.2025.2462380","url":null,"abstract":"","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2462380"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441748","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":"Artificial intelligence in kidney transplantation: a 30-year bibliometric analysis of research trends, innovations, and future directions.","authors":"Ying Jia He, Pin Lin Liu, Tao Wei, Tao Liu, Yi Fei Li, Jing Yang, Wen Xing Fan","doi":"10.1080/0886022X.2025.2458754","DOIUrl":"10.1080/0886022X.2025.2458754","url":null,"abstract":"<p><p>Kidney transplantation is the definitive treatment for end-stage renal disease (ESRD), yet challenges persist in optimizing donor-recipient matching, postoperative care, and immunosuppressive strategies. This study employs bibliometric analysis to evaluate 890 publications from 1993 to 2023, using tools such as CiteSpace and VOSviewer, to identify global trends, research hotspots, and future opportunities in applying artificial intelligence (AI) to kidney transplantation. Our analysis highlights the United States as the leading contributor to the field, with significant outputs from Mayo Clinic and leading authors like Cheungpasitporn W. Key research themes include AI-driven advancements in donor matching, deep learning for post-transplant monitoring, and machine learning algorithms for personalized immunosuppressive therapies. The findings underscore a rapid expansion in AI applications since 2017, with emerging trends in personalized medicine, multimodal data fusion, and telehealth. This bibliometric review provides a comprehensive resource for researchers and clinicians, offering insights into the evolution of AI in kidney transplantation and guiding future studies toward transformative applications in transplantation science.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2458754"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256458","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":"USP9X suppresses ferroptosis in diabetic kidney disease by deubiquitinating Nrf2 <i>in vitro</i>.","authors":"Ningjun Shao, Kedan Cai, Yue Hong, Lingping Wu, Qun Luo","doi":"10.1080/0886022X.2025.2458761","DOIUrl":"10.1080/0886022X.2025.2458761","url":null,"abstract":"<p><p>Nuclear factor erythroid 2-related factor 2 (Nrf2) regulates many critical genes associated with iron storage and transportation, the activity of which is influenced by E3 ligase-mediated ubiquitination. We wondered whether there is a deubiquitinase that mediates the deubiquitination of Nrf2 to stabilize Nrf2 expression and further prevent diabetic kidney disease (DKD). High glucose (HG) was applied to induce an <i>in vitro</i> model of DKD. The effects of HG on HK-2 cell viability, apoptosis, Fe²⁺ level, Nrf2, and ubiquitin-specific protease 9X (USP9X) were assessed by cell counting kit-8 (CCK-8) assay, flow cytometry, iron assay, and Western blot. The direct interaction between Nrf2 and USP9X was analyzed using co-immunoprecipitation and ubiquitination assay. After transfection and ferrostatin-1 (Fer-1) intervention, Nrf2 and USP9X levels, cell viability, apoptosis, and Fe²⁺ level were tested again. Reactive oxygen species (ROS), malondialdehyde (MDA), glutathione (GSH) contents, and ferroptosis-related markers were assessed by ROS assay kit, ELISA, and Western blot. HG reduced cell viability and levels of USP9X and Nrf2, while elevating apoptosis and Fe²⁺ level. An interaction between USP9X and Nrf2 has been verified and USP9X deubiquitinated Nrf2. Nrf2 up-regulation augmented the viability, GSH content, and ferroptosis-related protein expressions, while suppressing the apoptosis, Fe²⁺ level, MDA, and ROS content in HG-mediated HK-2 cells, which was reversed by USP9X silencing. Fer-1 offset the combined modulation of Nrf2 and siUSP9X on HG-induced HK-2 cells. USP9X mediates Nrf2 deubiquitinase to hamper the ferroptosis in DKD <i>in vitro</i>.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2458761"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449662","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 m6A reader YTHDF2 protects vascular smooth muscle cells against the osteogenic differentiation through targeting Runx2.","authors":"Lanmei Li, Meijuan Cheng, Jingjing Jin, Yunfeng Zhao, Weiwei Bai, Dongxue Zhang, Shenglei Zhang, Yaling Bai, Jinsheng Xu","doi":"10.1080/0886022X.2025.2488876","DOIUrl":"https://doi.org/10.1080/0886022X.2025.2488876","url":null,"abstract":"<p><p>Vascular calcification (VC) is an important pathological development progress in chronic kidney disease (CKD) and may increase mortality but lacks effective treatments. N6-methyladenosine (m6A) has been verified to be the most prevalent internal chemical RNA modification in mammalian mRNAs. The M6A-modified mRNA degradation process is mediated by the reader YTHDF2 in an m6A-dependent manner. Nevertheless, the exact role and molecular mechanism of YTHDF2 in VC remain unclear. This study aimed to investigate the potential role of YTHDF2 in the osteogenic differentiation of vascular smooth muscle cells (VSMCs). It was found that YTHDF2 was markedly downregulated in both <i>in vivo</i> and <i>in vitro</i> calcified models. Functionally, YTHDF2 plays a protective role in VC. The overexpression of YTHDF2 inhibited the transdifferentiation of VSMCs from a contractile to an osteogenic phenotype, thus decreasing the expression of mineralization regulatory proteins and calcium deposition. Conversely, YTHDF2 deficiency aggravated this process. At the mechanistic level, YTHDF2 suppressed osteogenic transdifferentiation of VSMCs by regulating the Runt-related transcription factor 2 (Runx2). RNA immunoprecipitation-qPCR (RIP-qPCR) confirmed the binding of YTHDF2 to Runx2, and luciferase reporter assays confirmed the presence of the m6A site in Runx2. In addition, an actinomycin D assay showed that the half-life of Runx2 mRNA was dramatically shortened in VSMCs overexpressing YTHDF2. These results suggest that YTHDF2 directly binds to the m6A modification site of Runx2 to mediate the mRNA degradation that prevents VC by inhibiting the osteogenic development of VSMCs. Therefore, YTHDF2 can be considered a potential therapeutic target for managing VC.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2488876"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042711","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":"Comprehensive profiling of cell type-specific expression and distribution of complement genes in mouse and human kidneys: insights into normal physiology and response to kidney transplantations.","authors":"Xianzhi Li, Li Zhu","doi":"10.1080/0886022X.2025.2471568","DOIUrl":"10.1080/0886022X.2025.2471568","url":null,"abstract":"<p><strong>Background: </strong>Recent studies innovatively revealed the localized expression of complement genes in kidneys and shed light on the vital roles of the intracellular complement system in the physiologic function and pathological conditions. However, a comprehensive analysis of the expression of complement genes in the context of the evolving cellular landscape of the kidney is not available.</p><p><strong>Methods: </strong>We analyzed single-cell RNA sequencing data from healthy human subjects, C57BL/6 mice, and kidney transplant-rejected mice. The data were sourced from the NCBI Gene Expression Omnibus and processed using quality control measures and unsupervised clustering. Differential gene analyses were based on expression levels.</p><p><strong>Results: </strong>In total, 50 complement genes were categorized into pattern recognition molecules, proteases, complement components, receptors, and regulators. In normal mice kidneys, complement genes were expressed at relatively low levels. Among different complement gene categories, receptor genes were most widely expressed in kidney cells. Comparatively, macrophages and mesangial cells are the most abundant immune and nonimmune cell types for complement gene expression. A comparison of human and mouse data showed similar expression patterns, but human kidney complement gene expression was more abundant. Comparative analysis between mouse transplant-rejected and normal kidneys demonstrated stronger complement gene expression in transplant-rejected kidneys.</p><p><strong>Conclusions: </strong>This study illustrated significant similarities in complement gene expression between murine and human kidneys and highlighted the responsive nature of complement genes to kidney injury, underscoring the dynamic nature of local complement regulation. These findings enhance our understanding of the complex regulation of the complement system within the kidney, offering insights into its role in renal disease pathogenesis.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2471568"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524279","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":"Oxidative stress and inflammation in hemodialysis: a comparison of patients with or without advanced nonalcoholic fatty liver disease (NAFLD).","authors":"Vanja Kalacun, Robert Ekart, Sebastjan Bevc, Pavel Skok, Radovan Hojs, Nina Vodošek Hojs","doi":"10.1080/0886022X.2025.2455523","DOIUrl":"10.1080/0886022X.2025.2455523","url":null,"abstract":"<p><p>Nonalcoholic fatty liver disease (NAFLD) and chronic kidney disease are global public health issues associated with high morbidity and mortality. Both diseases are also interlinked. Little is known about the meaning of NAFLD in hemodialysis (HD) patients. Therefore, the aim of our study was to investigate the difference in oxidative stress and inflammation in HD patients with or without advanced NAFLD. Seventy-seven HD patients were included (65.14 ± 12.34 years, 59.2% male) and divided according to abdominal ultrasound and two-dimensional shear wave elastography (2D-SWE) measurements into two groups: 1) no NAFLD or no advanced NAFLD (2D-SWE <9 kPa) and 2) advanced NAFLD (2D-SWE ≥9 kPa). Medical history data and blood results were collected. HD patients with advanced NAFLD had significantly higher levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG; <i>p</i> = 0.025), tumor necrosis factor-alpha (TNF-α; <i>p</i> = 0.023), and intercellular adhesion molecule 1 (ICAM-1; <i>p</i> = 0.015) in comparison to HD patients without advanced NAFLD. Interleukin 6 (IL-6) was higher in the advanced NAFLD group, but the difference was of borderline significance (<i>p</i> = 0.054). There was no significant difference in high-sensitivity C-reactive protein (hs-CRP), and vascular cell adhesion molecule 1 (VCAM-1) between groups. In binary logistic regression analysis, advanced NAFLD was significantly associated with 8-OHdG and ICAM-1. In conclusion, higher oxidative stress and inflammation levels are present in HD patients with advanced NAFLD.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2455523"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024531","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":"Elevated atherogenic index of plasma is associated with increased cardiorenal syndrome prevalence: a cross-sectional study.","authors":"Sikai Xu, Jianping Hu, Zhiyi Ouyang, Maolin Yuan, Yan Zheng, Xin Liu, Yang Shen","doi":"10.1080/0886022X.2025.2472037","DOIUrl":"10.1080/0886022X.2025.2472037","url":null,"abstract":"<p><strong>Purpose: </strong>Cardiorenal syndrome (CRS) is a complex clinical condition characterized by the simultaneous dysfunction of the heart and kidneys. The atherogenic index of plasma (AIP), calculated as the logarithm of the ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C), has emerged as a potential biomarker for cardiovascular risk. This study investigates the association between AIP and CRS, aiming to explore the potential linkage between AIP and CRS.</p><p><strong>Methods: </strong>Data were sourced from the National Health and Nutrition Examination Survey spanning 2005-2018, involving 35,365 participants after applying exclusion criteria. The primary exposure variable was AIP, categorized into quartiles, while the primary outcome variable was CRS, defined by the coexistence of cardiovascular disease (CVD) and chronic kidney disease (CKD). Statistical analyses, considering sample weights, included ANOVA, Chi-square tests, logistic regression models, and restricted cubic spline (RCS) analysis to examine nonlinear relationships.</p><p><strong>Results: </strong>The weighted logistic regression analysis showed a positive correlation between AIP and CRS across all models. In the fully adjusted model, the highest AIP quartile had a significantly increased odds ratio (OR) for CRS (Q4: OR = 1.62; 95% CI: 1.21-2.15). RCS analysis confirmed a positive correlation between AIP and CRS, with TG positively and HDL-C negatively correlated with CRS. Subgroup analysis indicated a significant interaction with hypertension, showing a stronger association in non-hypertensive individuals.</p><p><strong>Conclusion: </strong>Higher AIP levels are associated with an increased prevalence of CRS, with a notable hypertension-specific interaction indicating a higher effect in individuals without hypertension.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2472037"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537654","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 between drinking patterns and diabetic kidney disease in United States adults: a cross-sectional study based on data from NHANES 1999-2016.","authors":"Xusheng Yang","doi":"10.1080/0886022X.2025.2454970","DOIUrl":"10.1080/0886022X.2025.2454970","url":null,"abstract":"<p><strong>Objective: </strong>This cross-sectional study aimed to investigate the association between drinking patterns and prevalence of diabetic kidney disease (DKD) among adults in the United States.</p><p><strong>Methods: </strong>Data were analyzed from the NHANES surveys conducted between 1999 and 2016, including 26,473 participants. Drinking patterns were categorized by frequency (weekly, monthly, or yearly) and quantity (light, moderate, or heavy, based on daily consumption). Among participants with diabetes, DKD was defined using the albumin-to-creatinine ratio (ACR ≥30 mg/g) and estimated glomerular filtration rate (eGFR <60 mL/min/1.73 m²). Multivariable logistic regression models were used to evaluate associations, adjusting for potential confounders across the four models. Subgroup analyses were performed to assess the effects of modification by age, sex, race, BMI.</p><p><strong>Results: </strong>Drinking patterns and DKD were analyzed among 26,473 US adults (mean age, 46.6 years; 53.7% male). After adjusting for multiple confounders, heavy alcohol consumption was associated with a higher risk of DKD than light drinking (OR = 1.23, 95% CI, 1.04-1.46; <i>p</i> = 0.016). Conversely, moderate drinking frequency (3-4 days per week, 2-5 days per month, 3-126 days per year) was associated with a reduced DKD risk (OR = 0.67, 95% CI, 0.49-0.91; OR = 0.75, 95% CI, 0.56-0.99, OR = 0.71, 95% CI, 0.58-0.86, respectively). A nonlinear association was observed between alcohol consumption frequency and DKD in terms of weekly and yearly drinking days.</p><p><strong>Conclusion: </strong>This study highlights the importance of drinking behavior in the management of diabetic kidney disease. Daily alcohol consumption was associated with an increased risk of DKD, whereas moderate alcohol consumption was associated with a reduced risk. These findings suggest that moderate drinking frequency may not exacerbate renal burden in individuals with diabetes and provide new perspectives for clinical interventions.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2454970"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024530","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 association between the cystatin C- and creatinine-based estimated GFR ratio and post-ablation outcomes in patients with atrial fibrillation.","authors":"Wenchao Huang, Luxiang Shang, Yan Luo, Shiqiang Xiong, Shuwei Suo, Zhen Zhang, Hanxiong Liu, Huaxin Sun","doi":"10.1080/0886022X.2025.2466824","DOIUrl":"10.1080/0886022X.2025.2466824","url":null,"abstract":"<p><strong>Background: </strong>The difference between the cystatin C-based eGFR (eGFRcys) and the creatinine-based eGFR (eGFRcr) is associated with the risk of developing atrial fibrillation (AF) risk. However, its impact on AF ablation outcomes is unknown.</p><p><strong>Methods: </strong>The associations between the baseline eGFR ratio (eGFRcys/eGFRcr) and the risk of experiencing post-ablation endpoints were evaluated on a continuous scale (restricted cubic splines) and by a priori defined centile categories with Cox proportional hazards regression models. The primary endpoints were AF recurrence and adverse events; the secondary endpoint was rehospitalization.</p><p><strong>Results: </strong>Among 989 participants (49.2% women; mean age 65.7 years), 313 experienced AF recurrence after a median follow-up of 28 months. After full adjustment for confounding factors, a U-shaped association was observed between eGFR ratio and AF recurrence risk (minimum risk at 0.797). Although a U-shaped trend was observed, there was no statistically significant association between the eGFR ratio and adverse events or rehospitalization. Hazard ratios for AF recurrence, compared to the second quartile, were 1.68 (1.20-2.37) for the first quartile, 1.64 (1.15-2.34) for the third quartile, and 1.96 (1.37-2.80) for the fourth quartile. According to the subgroup analysis, the above association was strongly U-shaped for males and linear for females.</p><p><strong>Conclusion: </strong>In the AF population, both low and high eGFR ratios were associated with an increased risk of post-ablation AF recurrence.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2466824"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483960","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 clinical outcomes of acute kidney injury substages based on serum cystatin C in pediatric patients undergoing cardiac surgery.","authors":"Yinan Li, Dongyun Bie, Chao Xiong, Sheng Shi, Zhongrong Fang, Zhongyuan Lu, Jianhui Wang","doi":"10.1080/0886022X.2025.2466114","DOIUrl":"10.1080/0886022X.2025.2466114","url":null,"abstract":"<p><strong>Background: </strong>Multiple biomarkers have been identified by previous studies to diagnose acute kidney injury (AKI). The combination of biomarkers with conventional criteria to define AKI substages in order to identify high-risk patients and improve diagnostic accuracy was recommended. Our study aimed to explore the incidence of AKI substages defined by serum cystatin C (CysC), determine whether AKI substages diagnosed with combined CysC criteria were associated with worse outcomes.</p><p><strong>Methods: </strong>We prospectively included 2519 pediatric patients (<16 years) undergoing cardiac surgery with cardiopulmonary bypass (CPB) in our cohort between March 2022 and February 2023 in Fuwai Hospital. Demographic and clinical variables were collected. To define AKI substages, Kidney Disease: Improving Global Outcomes AKI definition (based on serum creatinine (SCr) or CysC) was used. The association between AKI exposure and outcomes including length of intensive care unit stay (LOIS), duration of mechanical ventilation (DMV), length of hospital stay (LOHS), and 30-day mortality was assessed. In addition, we determined areas under the receiver operating characteristic (ROC) curve and cutoff value of CysC preoperatively and postoperatively to predict AKI.</p><p><strong>Results: </strong>Five hundred and seven (20.8%) patients developed SCr-AKI, with 337 (13.8%) in stage 1, 77 (3.2%) in stage 2 and 93 (3.8%) in stage 3, respectively. Of the 1925 patients without SCr-AKI, 256 (14.3%) met the definition of sub-AKI. Of the 507 patients with SCr-AKI, 281 (55.4%) patients were defined as AKI substage A, while others (226, 44.6%) were defined as AKI substage B. After adjusting for body surface area, neonates, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality score ≥ 4, previous sternotomy and CPB time > 120 min, the postoperative LOIS, LOHS, and DMV were prolonged with increasing hospitalization expense (<i>p</i> < .05) in patients with SCr-AKI and/or CysC-AKI. Meanwhile, only the hospitalization expense was increased in patients with SCr-AKI (<i>p</i> < .05) after the same adjustment. The area under curves was 0.691, 0.720, and 0.817 respectively, in ROC curves of preoperative, relative variation, or postoperative serum CysC. DeLong's test showed that postoperative serum CysC might have better diagnostic performance characteristics than preoperative or relative variation of CysC (<i>p</i> < .001), with cutoff point at 1.29 mg/dL (specificity, 0.77; sensitivity, 0.71).</p><p><strong>Conclusions: </strong>Our analysis indicates defining AKI with both CysC and SCr might more significantly affect clinical outcome associations in pediatric patients undergoing cardiac surgery. Moreover, the serum CysC cutoff of 1.29 mg/dL postoperatively is a valuable threshold for AKI risk assessment to define AKI subtypes.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2466114"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469064","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}