Saudi Journal of Kidney Diseases and Transplantation最新文献

{"title":"Causes and clinical outcomes of pregnancy-related acute kidney injury: A single-center tertiary hospital study in Abu Dhabi, United Arab Emirates.","authors":"Hefsa Al Shamsi, Salama Al Falahi, Bashir Taha Salih, Saleema Wani, Fathima Shireen Farook","doi":"10.4103/sjkdt.sjkdt_107_26","DOIUrl":"10.4103/sjkdt.sjkdt_107_26","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy-related acute kidney injury (prAKI) remains a serious complication associated with maternal and fetal morbidity, with significant regional variation. Data from the Middle east are limited. This study aimed to investigate the causes and outcomes of prAKI in a tertiary hospital in Abu Dhabi.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of pregnant women with prAKI at Corniche Hospital, Abu Dhabi, between 2019 and 2023. AKI was defined according to the Kidney Disease Improving Global Outcomes criteria as any of the following ≥1.5-fold increase in serum creatinine from the baseline within 7 days or ≥0.3 mg/dl (≥26.5 μmol/L) increase from the baseline within 48 h. Baseline serum creatinine was defined as the most recent creatinine value within 1 year prior to the index pregnancy. In cases where baseline creatinine was not available, the lowest serum creatinine value recorded after recovery was used as a surrogate baseline. Complete renal recovery is the return to baseline serum creatinine, and partial recovery if the creatinine did not return to baseline.</p><p><strong>Results: </strong>A total of 167 patients had prAKI over a 5-year study period. The most common cause of prAKI was preeclampsia, accounting for 65 cases (39%), followed by infection, 30 cases (18%) of the cases. The majority of cases were classified as mild acute kidney injury (AKI) (75.5%), while moderate and severe AKI accounted for 16% and 8%, respectively. Maternal outcomes were generally favorable, with a low mortality rate (0.6%). Complete renal recovery was observed in 148 patients (88.6%), eight patients progressed to chronic kidney disease, while follow-up serum creatinine was not done in 11 patients (6.6%). Only two patients required transient renal replacement therapy. prAKI was recognized and documented by the obstetric team in 60% of the cases.</p><p><strong>Conclusion: </strong>In this cohort, prAKI was predominantly mild and associated with favorable maternal outcomes, likely reflecting early detection and management in a tertiary care hospital. However, under-recognition of prAKI remains a concern. Multidisciplinary collaboration between obstetric and nephrology teams is key for prevention, early recognition, and management of AKI.</p>","PeriodicalId":21356,"journal":{"name":"Saudi Journal of Kidney Diseases and Transplantation","volume":" ","pages":"176-181"},"PeriodicalIF":0.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nephrology services during Hajj: A mature model of mass-gathering kidney care.","authors":"Khalid Alhasan, Abduljaleel Alhindi, Ahmed Ayed Alzaidi, Badr Alhomayeed, Ibrahim Joharji, Mohamad-Hani Temsah","doi":"10.4103/sjkdt.sjkdt_297_26","DOIUrl":"https://doi.org/10.4103/sjkdt.sjkdt_297_26","url":null,"abstract":"","PeriodicalId":21356,"journal":{"name":"Saudi Journal of Kidney Diseases and Transplantation","volume":"37 3","pages":"133-135"},"PeriodicalIF":0.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Peritoneal dialysis therapy discontinuation due to noninfectious complications: Insights from a retrospective study in end stage renal disease patients from Saudi Arabia.","authors":"Gamze Ergün","doi":"10.4103/sjkdt.sjkdt_234_26","DOIUrl":"https://doi.org/10.4103/sjkdt.sjkdt_234_26","url":null,"abstract":"","PeriodicalId":21356,"journal":{"name":"Saudi Journal of Kidney Diseases and Transplantation","volume":"37 3","pages":"217-218"},"PeriodicalIF":0.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value of repeat renal biopsy in lupus nephritis: Histological transitions, treatment impact, and predictors of repeat biopsy and active disease.","authors":"Mohamed Bedaiwi, Najma Khalil, Ibrahim Almaghlouth, Fehaid G Alanazi, Aos Aboabat, Abdurhman Saud Alarfaj","doi":"10.4103/sjkdt.sjkdt_152_26","DOIUrl":"10.4103/sjkdt.sjkdt_152_26","url":null,"abstract":"<p><strong>Background: </strong>Repeat renal biopsy frequently reveals the changes in the histological pattern in lupus nephritis (LN) which can guide alterations in therapeutic decisions. However, the choice of which patients should undergo such a repetition on clinical ground remains insufficiently defined. We sought to identify independent clinical predictors for repeat biopsy.</p><p><strong>Patients and methods: </strong>We retrospectively evaluated 370 patients with biopsy-proven LN. A clinically indicated second renal biopsy was performed in 122 patients (33%) due to acute renal flares, persistent disease activity, or suspected progression. LN classes were classified as nonproliferative (classes I, II, V, and VI) or proliferative (classes III, IV, and mixed). Crude odds ratios (ORs) and multivariable logistic regression models adjusting for baseline age, sex, and LN classification were utilized to identify independent predictors. The treatment regimens were consolidated into broad categories of clinical management subsets to evaluate the changes in therapeutic pathways.</p><p><strong>Results: </strong>The initial biopsies showed, 30.5% of patients had nonproliferative and 69.5% proliferative LN. Histological transformation occurred in 68% of the repeat biopsies. Mixed LN classes increased significantly in the second biopsy from 7.4% to 22.9% ( P < 0.05). Multivariable regression identified longer systemic lupus erythematosus (SLE) disease duration as the sole independent clinical predictor for undergoing a second biopsy (22.2 ± 4.96 vs. 17.2 ± 6.29 years; adjusted OR = 1.15, 95% confidence interval [CI]: 1.06-1.25), indicating that shorter SLE duration corresponds to clinical stability and conservative management without rebiopsy. Baseline proliferative LN independently predicted active disease on repeat biopsy (Adjusted OR = 2.42, 95% CI: 1.09-5.38). Repeat biopsy findings led to immediate therapeutic modification in 82.8% of patients, most commonly therapy intensification in those with active proliferative transformations.</p><p><strong>Conclusions: </strong>Repeat renal biopsy revealed high rates of histological transitions and directly guided alterations in therapeutic adjustment. A longer SLE duration predicted the need for repeat renal biopsy, and a baseline proliferative LN strongly predicts active disease on re-biopsy. Although long-term survival benefits cannot be inferred from this retrospective cohort, repeat renal biopsy remains an indispensable tool for optimizing individualized immunosuppressive therapy.</p>","PeriodicalId":21356,"journal":{"name":"Saudi Journal of Kidney Diseases and Transplantation","volume":" ","pages":"204-209"},"PeriodicalIF":0.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepcidin in iron management in chronic kidney disease patients on hemodialysis: A translational and clinical review of mechanisms, evidence, and implementation barriers.","authors":"Samarth R Anigol, Geetanjali S Salimath, Mallikarjun S Karishetti","doi":"10.4103/sjkdt.sjkdt_149_26","DOIUrl":"10.4103/sjkdt.sjkdt_149_26","url":null,"abstract":"<p><strong>Abstract: </strong>Iron dysregulation is common in hemodialysis patients with chronic kidney disease (CKD), which significantly increases anemia and makes therapeutic management more challenging. The master regulator of systemic iron homeostasis has emerged as a promising biomarker and potential therapeutic target for optimizing iron therapy in this population. This comprehensive narrative review synthesizes current evidence on hepcidin's role in iron management in hemodialysis patients with CKD, examining its diagnostic and prognostic value, its pathophysiological interactions with inflammation and erythropoiesis, and the obstacles to its integration into standard clinical practice. This narrative review is based on a structured literature search of PubMed, Scopus, and Google Scholar (inception to March 2026); eligible English language studies on hepcidin in CKD and hemodialysis were selected through screening and full-text review and synthesized qualitatively. The review further evaluates the cost-effectiveness of hepcidin testing versus standard iron markers from a healthcare system perspective. Key barriers, including assay non-standardization, the absence of validated clinical thresholds, and the lack of reimbursement pathways, are critically appraised alongside emerging evidence supporting hepcidin-guided anemia management.</p>","PeriodicalId":21356,"journal":{"name":"Saudi Journal of Kidney Diseases and Transplantation","volume":" ","pages":"144-152"},"PeriodicalIF":0.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Divergent practice patterns in lupus nephritis care: A national survey of rheumatologists and nephrologists in Saudi Arabia.","authors":"Fadel A Alrowaie, Mohammed A Omair, Mohamed W Shantier, Mohammad A Mustafa","doi":"10.4103/sjkdt.sjkdt_113_26","DOIUrl":"10.4103/sjkdt.sjkdt_113_26","url":null,"abstract":"<p><strong>Background: </strong>Lupus nephritis (LN) carries significant morbidity and mortality and demands coordinated, multidisciplinary care. Given the complexity of diagnosis, immunosuppressive therapy, and long-term renal monitoring, collaboration between rheumatologists and nephrologists is essential.</p><p><strong>Aims: </strong>This study aimed to investigate specialty-driven similarities and differences in the management of patients with LN in Saudi Arabia.</p><p><strong>Subjects and methods: </strong>A cross-sectional, self-reported, electronic survey was distributed to adult rheumatologists and nephrologists practicing in Saudi Arabia, achieving a response rate of 31% (158 of 500 clinicians contacted through national specialty-society distribution lists). The questionnaire assessed demographic characteristics, institutional settings, and LN management practices. Associations between specialty and survey responses were analyzed using Pearson's Chi-square or Fisher's exact tests, with statistical significance defined as a two-sided P < 0.05.</p><p><strong>Results: </strong>A total of 158 clinicians participated, with equal representation of rheumatologists and nephrologists (79 each). Nephrologists were more frequently male (81.0% vs. 60.8%; χ2P = 0.005), whereas rheumatologists were younger and had fewer years of clinical experience ( P = 0.005). Marked specialty-based differences were observed in induction strategies. Rheumatologists more frequently administered higher-dose pulse methylprednisolone (1000 mg vs. 500 mg; P = 0.015) and were more likely to prescribe mycophenolate mofetil for Class III/IV ± V LN (88.6% vs. 73.4%). In contrast, nephrologists demonstrated greater reliance on cyclophosphamide-based regimens (26.6% vs. 11.4%; P = 0.015). Significant variation was also evident in supportive care practices. Nephrologists more commonly prescribed Pneumocystis jirovecii pneumonia (PJP) prophylaxis (22.8% vs. 5.1%; P = 0.005), while rheumatologists more frequently implemented gonadal protection during cyclophosphamide therapy (94.6% vs. 74.0%; P = 0.003).</p><p><strong>Conclusion: </strong>Variation in LN management was observed between rheumatologists and nephrologists in Saudi Arabia, highlighting potential care gaps and areas for standardization. A multidisciplinary approach can lead to more comprehensive, unified care. Future studies are recommended to evaluate quality indicators in the management of LN.</p>","PeriodicalId":21356,"journal":{"name":"Saudi Journal of Kidney Diseases and Transplantation","volume":" ","pages":"196-203"},"PeriodicalIF":0.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peritoneal dialysis in patients with end-stage renal disease, chronic liver disease and ascites: A prospective observational study.","authors":"Abdullah Al-Hwiesh, Ibrahiem Saeed Abdul-Rahman, Mohammed Ahmed Nasreldin, Moaz Abdulgalil, Khadija M Alshehabi, Nadia Al-Audah, Abdullah D Alotibi, Suzan Aloudah","doi":"10.4103/sjkdt.sjkdt_205_25","DOIUrl":"10.4103/sjkdt.sjkdt_205_25","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with chronic liver disease (CLD) complicated by ascites may develop end-stage renal disease (ESRD), making selection of renal replacement therapy challenging. This study described the feasibility and clinical outcomes of peritoneal dialysis (PD) in selected patients with ESRD, CLD, and ascites.</p><p><strong>Patients and methods: </strong>This prospective observational study included 51 selected patients with ESRD, CLD, and ascites and 55 patients with ESRD without CLD who underwent PD at a tertiary university hospital in Saudi Arabia. All underwent percutaneous insertion of a three-cuff PD catheter and received automated peritoneal dialysis (APD). Clinical outcomes recorded during observed follow-up are presented descriptively.</p><p><strong>Results: </strong>Percutaneous catheter insertion was successful in all patients without bowel perforation, catheter migration, or major hemorrhage. Thirteen peritonitis episodes were recorded in the CLD group and 12 in the non-CLD group. The overall peritonitis rate was 0.10 episodes per patient-year; group-specific rates were 0.11 and 0.09 episodes per patient-year, respectively. None required catheter removal. A transient serum albumin decline of at least 0.5 g/dL was recorded in 5 and 4 patients, respectively. Early dialysate leakage occurred in 7/51 and 3/55 patients and was managed by temporary reduction of fill volume. During observed follow-up, 12/51 patients with CLD and 9/55 patients without CLD died.</p><p><strong>Conclusions: </strong>Peritoneal dialysis was feasible in this selected cohort of patients with ESRD, chronic liver disease, and ascites. The observed adequacy values, complication counts, and crude mortality are reported descriptively. The findings should not be interpreted as establishing safety, effectiveness, equivalence, or superiority.</p>","PeriodicalId":21356,"journal":{"name":"Saudi Journal of Kidney Diseases and Transplantation","volume":"37 3","pages":"210-216"},"PeriodicalIF":0.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimation of Thoracic Fluid Content by Using Non-Invasive Cardiometry in Critically Ill Children with Acute Kidney Injury.","authors":"Rasha Helmy, Aya O Mohammed, Hafez M Bazaraa, Aly ElKazaz","doi":"10.4103/sjkdt.sjkdt_562_21","DOIUrl":"https://doi.org/10.4103/sjkdt.sjkdt_562_21","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is frequently seen in critically ill children. Appropriate assessment of fluid status is needed in those with AKI as either excess fluid removal or fluid overload is associated with high morbidity and poor clinical outcome. This study aims to evaluate the clinical utility of thoracic fluid content (TFC) measured by cardiometry as an indicator of fluid status in critically ill children with AKI. Electrical cardiometry; a variation of impedance cardiography is a device that measures stroke volume using changes in thoracic resistance associated with blood flow during the cardiac cycle ,TFC is correlated with electrical impedance.</p><p><strong>Methods: </strong>A cross-sectional study was done over a period of one year including 72 critically ill children with AKI. Estimation of TFC has been made at the onset of AKI and during follow-up to determine the fluid status, in association with other clinical and imaging parameters.Patients were divided into two groups according to the management: the conservative group (n=49) of patients who did not require renal replacement therapy, and the dialysis group (n=23).</p><p><strong>Results: </strong>TFC changes positively correlated with percent cumulative fluid balance (r=0.316, p=0.007) and with central venous pressure changes (r=0.617, p=0.002; r=0.6,p=0.00) in dialysis and conservative groups respectively. Patients with fluid overload who have undergone dialysis had significantly higher median TFC compared to those not requiring dialysis or dialyzed for other indications both at the onset and follow-up of AKI (p=0.03 and 0.043 respectively).</p><p><strong>Conclusions: </strong>TFC measurement by electrical impedance is a promising tool for monitoring fluid status in children with AKI.</p>","PeriodicalId":21356,"journal":{"name":"Saudi Journal of Kidney Diseases and Transplantation","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148205875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Pathological Faces of IgM Deposition in Children with Idiopathic Nephrotic Syndrome: A Single Center Experience.","authors":"Fatma Mutlubaş, Gökçen Erfidan, Eren Soyaltın, Seçil Arslansoyu Çamlar, Demet Alaygut, Emel Tekin, Belde Kasap Demir","doi":"10.4103/sjkdt.sjkdt_512_21","DOIUrl":"https://doi.org/10.4103/sjkdt.sjkdt_512_21","url":null,"abstract":"<p><strong>Background: </strong>Immunoglobulin M nephropathy (IgMN) is a pathological term defining glomerulonephritis with IgM deposition. The clinical significance is still a matter of debate. The aim was to evaluate children with IgM nephropathy (IgMN) in terms of clinical and pathological features, along with treatment responses and outcomes.</p><p><strong>Materials and methods: </strong>The children with idiopathic nephrotic syndrome (INS) who underwent kidney biopsy at our center (n=41) were evaluated retrospectively. Twenty-one children with IgMN were included.</p><p><strong>Results: </strong>The female to male ratio was 0.9, the median age was 3.5 years in the study group. The mean disease duration and follow-up periods were 11.8 and 11.3years, respectively. At admission, 14% of the patients had hypertension, and 19% had microscopic hematuria. Steroid-dependent nephrotic syndrome (SDNS) was observed in 62% of the patients at admission and 81% at last visit. The patients with IgM (≥2+) depositions had more SDNS than those with IgM (1+). The most common light microscopic diagnosis was mesangial proliferative glomerulonephritis (MesPGN) (47.6%). Focal segmental glomerulosclerosis (FSGS) elevated significantly from 14% at initial biopsy to 57% at follow-up biopsies. Patients who progressed to FSGS mostly had C3 co-deposition, high IgM intensity (≥2+), diagnosis of MesPGN, and SDNS clinic. The most frequently used adjuvant agent was cyclosporine-A (n=19) with mean duration of 68 months. It provided lower relapse rates. Rituximab (n=4) showed 75% remission rate. None of the patients had needed renal replacement treatment. Two patients who were steroid-resistant at admission had FSGS in their first biopsies, acted as multi-drug resistance at follow-up, and ended up in Stage-2 chronic kidney disease (CKD).</p><p><strong>Conclusion: </strong>This study shows IgMN is mainly presented with SDNS clinic and MesPGN pathology. Evolution to FSGS may be related to steroid resistance, MesPGN, high IgM intensity, and C3 co-deposition.</p>","PeriodicalId":21356,"journal":{"name":"Saudi Journal of Kidney Diseases and Transplantation","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148205884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"U- Shaped Association of Serum Parathyroid Hormone and Cognitive Dysfunction in Maintenance Haemodialysis Patients.","authors":"Yaser A Ammar","doi":"10.4103/sjkdt.sjkdt_185_21","DOIUrl":"https://doi.org/10.4103/sjkdt.sjkdt_185_21","url":null,"abstract":"<p><strong>Objectives: </strong>Primary hypo- or hyperparathyroidism may present with cognitive dysfunction (CODY). Parathyroid disorders commonly occur in end-stage renal disease (ESRD) patients treated with maintenance haemodialysis (MHD) and may contribute to the accelerated cerebrovascular atherosclerotic calcification and neuropsychologic disorders prevalent in them. The relationship between serum intact parathyroid hormone (S.iPTH) and cognitive function in these patients remains to be fully explored.</p><p><strong>Methods: </strong>Seventy-two stable ESRD patients (39 males, median age 50y) treated with thrice-weekly low-flux MHD for >6 months were tested by Montreal cognitive assessment-basic version (MoCA-B), geriatric depression scale- short form and pre-dialysis assessment of S.iPTH, vitamin D3, alkaline phosphatase, urea, creatinine, calcium, phosphorus and haemoglobin.</p><p><strong>Results: </strong>CODY and depression occurred in 51.4% and 65.3% of patients, respectively. A quadratic inverted U-shaped curve provided the best fit for the relation between S.iPTH and MoCA-B score (P=0.019). In the adjusted model, older age, lower haemoglobin, and higher S.iPTH predicted worse cognitive function.</p><p><strong>Conclusions: </strong>CODY and depression are prevalent but largely unrecognized problems in older adult MHD patients. Short, easy-applicable neuropsychologic screening tests should help detection and management of these problems. Both markedly increased and relatively suppressed (but supranormal) S.iPTH levels are associated with CODY in them. This U-shaped association underscores the need to maintain some degree of secondary (adaptive) hyperparathyroidism. Calcium-based phosphorus binders and calcimimetics should be used cautiously in MHD patients to avoid overzealous suppression of PTH secretion which may disturb the bone-vascular axis and promote early vascular dementia. Large-scale prospective studies are needed to define the target S.iPTH range.</p>","PeriodicalId":21356,"journal":{"name":"Saudi Journal of Kidney Diseases and Transplantation","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}