Nefrologia English Edition最新文献

{"title":"Primary renal tubular acidosis during pregnancy, what about the perinatal prognosis? A case report and literature review","authors":"Johan Van Laethem ,&nbsp;Lucie Seyler ,&nbsp;Annelies Tonnelier","doi":"10.1016/j.nefroe.2025.04.002","DOIUrl":"10.1016/j.nefroe.2025.04.002","url":null,"abstract":"<div><div>Renal tubular acidosis (RTA) is a group of disorders caused by tubular defects leading to defective reabsorption of bicarbonate (HCO₃⁻) and/or secretion of protons (H⁺). It is known that pregnancy can induce or worsen some forms of RTA. To date, no systematic data exist on the course of pregnancy in hereditary RTA-affected mothers, nor on the outcome of both mothers and children.</div><div>A 35-year-old female patient attends her routine obstetric follow-up consultation at 32-weeks’ pregnancy. From the 6th week of gestation, she has been complaining of general malaise, accompanied by paraesthesia in both hands. She is known to have renal tubular acidosis type 1, carrying a mutation in the SLC4A1 gene encoding for the bicarbonate-chloride exchanger located in the alpha-intercalated cell of the renal collecting tubule. At week 32, serum bicarbonate levels appeared to be 11<!--> <!-->mEq/l. The patient was hospitalised and treated with intravenous sodium bicarbonate and potassium chloride. After 5 days, the symptoms resolved, and her bicarbonate level had normalised. A healthy infant was born with a normal Apgar score. Carriage of the same mutation was found in the child at 16 months. Our literature study shows that 12 of the 13 reported infants born from a mother with primary RTA were healthy at delivery. One neonate revealed signs of hyperparathyroidism at day 2, but those signs resolved at 1 month of age.</div><div>RTA during pregnancy is often associated with decompensation and worsening of acidosis. More attention should be paid to patients with RTA suffering from hyperemesis gravidas, in particular regarding therapy adherence. Our literature review focusses on foetal prognosis, which seems to be favourable in most of the reported pregnancies.</div></div>","PeriodicalId":31770,"journal":{"name":"Nefrologia English Edition","volume":"45 4","pages":"Pages 329-336"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873238","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 Practice Guideline for detection and management of diabetic kidney disease: A consensus report by the Spanish Society of Nephrology","authors":"Nuria Montero ,&nbsp;Laia Oliveras ,&nbsp;Alberto Martínez-Castelao ,&nbsp;José Luis Gorriz ,&nbsp;María José Soler ,&nbsp;Beatriz Fernández-Fernández ,&nbsp;Maria Quero ,&nbsp;Clara García-Carro ,&nbsp;Paula Garcia-Sancho ,&nbsp;Marian Goicoechea ,&nbsp;Juan Jose Gorgojo Martínez ,&nbsp;Pablo Molina ,&nbsp;María Jesús Puchades ,&nbsp;Diana Rodríguez-Espinosa ,&nbsp;Nery Sablón ,&nbsp;Rafael Santamaría ,&nbsp;Juan Francisco Navarro-González ,&nbsp;on behalf of GEENDIAB (Spanish Diabetic Nephropathy Study Group)","doi":"10.1016/j.nefroe.2025.04.005","DOIUrl":"10.1016/j.nefroe.2025.04.005","url":null,"abstract":"<div><div>To address all the changes in the management of people with diabetes (DM) and chronic kidney disease (CKD), under the auspices of the Spanish Society of Nephrology (SEN), the Spanish Diabetic Nephropathy Study Group (GEENDIAB) decided to publish an updated Clinical Practice Guideline for detection and management of diabetic kidney disease (DKD). It is aimed at a wide audience of clinicians treating diabetes and CKD. The terminology of kidney disease in diabetic patients has evolved toward a more inclusive nomenclature that avoids underdiagnosis of this entity. Thus, the terms “diabetes and kidney disease” and “diabetic kidney disease” are those proposed in the latest KDIGO 2022 guidelines to designate the whole spectrum of patients who can benefit from a comprehensive therapeutic approach only differentiated according to eGFR range and albuminuria.</div><div>Recommendations have been divided into five main areas of interest: Chapter 1: Screening and diagnosis of diabetic kidney disease, Chapter 2: Metabolic control in people with diabetes and CKD, Chapter 3: Blood pressure control in people with diabetic kidney disease, Chapter 4: Treatment targeting progression of CKD in people with diabetic kidney disease, and Chapter 5: Antiplatelet or anticoagulant therapy in people with diabetes and CKD.</div><div>World Health Organization (WHO) recommendations for guideline development were followed to report this guideline. Systematic reviews were carried out, with outcome ratings and summaries of findings, and we reported the strength of recommendations following the “Grading of Recommendations Assessment, Development and Evaluation” GRADE evidence profiles.</div></div>","PeriodicalId":31770,"journal":{"name":"Nefrologia English Edition","volume":"45 ","pages":"Pages 1-26"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143815339","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":"Obinutuzumab in focal segmental glomerulonephritis resistant to treatment","authors":"Byron Chiliquinga Morales ,&nbsp;Pablo Sánchez Garrote ,&nbsp;Astrid Rodríguez Gómez ,&nbsp;Carmen Martin Varas ,&nbsp;Paulo García Gutiérrez ,&nbsp;Ana Saiz González ,&nbsp;Leonardo Calle García ,&nbsp;Carlos Santos Alonso ,&nbsp;Claudia Muñoz Martínez ,&nbsp;Nieves Losada de la Rosa ,&nbsp;Enrique Morales ,&nbsp;María José Fernández-Reyes Luis","doi":"10.1016/j.nefroe.2025.03.005","DOIUrl":"10.1016/j.nefroe.2025.03.005","url":null,"abstract":"","PeriodicalId":31770,"journal":{"name":"Nefrologia English Edition","volume":"45 4","pages":"Pages 348-350"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873583","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":"Review and practical excursus on the comparison between traditional statics methods and Classification And Regression Tree (CART) in real-life data: Low protein diet compared to Mediterranean diet in patients with chronic kidney disease","authors":"Vincenzo Calabrese ,&nbsp;Daniela Metro ,&nbsp;Angela Alibrandi ,&nbsp;Domenico Maviglia ,&nbsp;Valeria Cernaro ,&nbsp;Veronica Maressa ,&nbsp;Elisa Longhitano ,&nbsp;Guido Gembillo ,&nbsp;Domenico Santoro","doi":"10.1016/j.nefroe.2025.04.008","DOIUrl":"10.1016/j.nefroe.2025.04.008","url":null,"abstract":"<div><div>The Classification and Regression Tree (CART) is a supervised learning approach useful used to segment the space of and the predictors/features space into smaller homogeneous regions that are, represented in a decision tree. It computes the selection of features automatically, in contrast to traditional statistic methods. In this review, we compared CART to traditional statistics in patients who did not attempt a diet to patients who followed a low-protein diet (LPD) or the Mediterranean diet in chronic kidney disease (CKD) patients, and we analyzed them using linear regression and CART methods. In our example, diet adherence proved to be the factor with the greatest impact on renal function decline, but CART failed to detect significant differences between LPD and Mediterranean diet. Similar results were found using traditional statics, but CART gave a model with the proportion of the explained outcome by the model (<em>R</em>²) higher by about 20%, thus a stronger model. In addition, CART allows quick and easy identification of the variables affecting the outcome with a simple visual representation through the decision tree, increasing the interpretability of the results. In summary, no difference in the impact of variables has been detected with the two methods, but CART gave us a more detailed model with a faster and easier interpretation.</div></div>","PeriodicalId":31770,"journal":{"name":"Nefrologia English Edition","volume":"45 4","pages":"Pages 279-284"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873332","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":"POCUS ultrasound: A tool for the detection and monitoring of sarcopenia in peritoneal dialysis","authors":"Estefanya García-Menéndez ,&nbsp;Jose Portolés ,&nbsp;Irene Pérez Rodrigo ,&nbsp;Ana Tato Ribera ,&nbsp;Claudia Yuste Lozano ,&nbsp;Marta Ossorio González ,&nbsp;María Jesús Álvarez López ,&nbsp;Paula López Sánchez ,&nbsp;Darío Janeiro Marín","doi":"10.1016/j.nefroe.2025.03.003","DOIUrl":"10.1016/j.nefroe.2025.03.003","url":null,"abstract":"&lt;div&gt;&lt;div&gt;The prevalence of Sarcopenia varies between 1.5% and 68% among patients with chronic kidney disease (CKD). This wide range is due to the different diagnostic tools and the cut-off points used. Early diagnosis and intervention of sarcopenia are essential because of its association with poorer quality of life (QoL), higher hospitalization rates, and adverse events. The “European Working Group on Sarcopenia in Older People (EWGSOP2)” consensus review suggests ultrasound as an emerging tool to quantify muscle mass. Our objective is to describe the prevalence of sarcopenia risk in peritoneal dialysis (PD) and the utility of ultrasound in our setting.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Material and methods&lt;/h3&gt;&lt;div&gt;We conducted an observational study in prevalent PD patients at the Puerta de Hierro University Hospital between January and October 2023. Clinical, efficacy, analytical and nutritional parameters were collected, along with functional performance measured by SPPB, frailty (FRAIL scale), risk of malnutrition (MIS scale), bioimpedance (BCM) and estimation of appendicular skeletal muscle mass using Lin’s formula. Ultrasound measurement of supramuscular fat, Axes (X and Y) and the area of the rectus femoris muscle (RFM) were also included, adjusted for height and body surface area. We classified patients at risk of sarcopenia based on handgrip strength according to EWGSOP2 criteria, adjusted for sex. This study was approved by the Ethics Committee of Puerta de Hierro University Hospital (No. 16/2023).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We evaluated 38 patients, with a mean age of 65.4 years (SD 14.9), 65.8% were male. 52.6% had a reduced lean tissue index (LTI) and 23.7% had a reduced fat tissue index (FTI), with a mean phase angle (PA) of 4.5 (SD 1.1). We classified 42.1% as patients at risk of sarcopenia based on handgrip strength. They were older, had more comorbidities, poorer nutrition according to the MIS scale, and showed worse scores on frailty and functional capacity. Similary, they had a lower LTI, lower appendicular skeletal muscle mass, and lower quadriceps muscle thickness (Y axis 8.5 mm (SD 2.4) vs 11.8 mm (SD 3.3) &lt;em&gt;p&lt;/em&gt; = 0.002). Patients at risk of sarcopenic had lower phosphorus levels and higher C-reactive protein (CRP) levels. The predictive capacity of ultrasound for classifying patients at risk of sarcopenia was AUC 0.78 (0.64−0.93) for Y Axis, similar to those obtained with the LTI and PA of bioimpedance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Sarcopenia risk is highly prevalent in PD and is related to age, comorbidity, malnutrition and inflammation in patients. Ultrasound is an accessible, safe, low-cost and easy-to-use tool at the bedside. This method helps us to quantify muscle mass and assess its quality. We propose the thickness of the RFM (Y axis) as the best complementary parameter given its good correlation with bioimpedance and its diagnostic value for sarcopenic risk. Our experience will serve as a basis for f","PeriodicalId":31770,"journal":{"name":"Nefrologia English Edition","volume":"45 4","pages":"Pages 302-311"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744089","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":"First page","authors":"","doi":"10.1016/S2013-2514(25)00062-8","DOIUrl":"10.1016/S2013-2514(25)00062-8","url":null,"abstract":"","PeriodicalId":31770,"journal":{"name":"Nefrologia English Edition","volume":"45 ","pages":"Page i"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143815338","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":"Spanish Registry of Renal Patients: 2022 Report and evolutive analysis","authors":"Borja Quiroga ,&nbsp;Beatriz Mahíllo ,&nbsp;Auxiliadora Mazuecos ,&nbsp;Alberto Ortiz ,&nbsp;Jordi Comas Farnés ,&nbsp;Domingo Hernández Marrero ,&nbsp;Sara Trujillo Alemán ,&nbsp;M. Carmen Santiuste de Pablos ,&nbsp;Olga Lucía Rodríguez Arévalo ,&nbsp;María Marques Vidas ,&nbsp;M. Fernanda Slon-Roblero ,&nbsp;Marta Artamendi Larrañaga ,&nbsp;Iñigo Moina Eguren ,&nbsp;María de la Oliva Valentín Muñoz ,&nbsp;Marta Rodríguez Camblor ,&nbsp;Inmaculada Moreno Alia ,&nbsp;Mª Encarnación Bouzas Caamaño ,&nbsp;Mª Antonia Blanco Galán ,&nbsp;Javier Deira Lorenzo ,&nbsp;Héctor García López ,&nbsp;Emilio Sánchez Álvarez","doi":"10.1016/j.nefroe.2025.03.002","DOIUrl":"10.1016/j.nefroe.2025.03.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic kidney disease (CKD) will be the second leading cause of death in Spain by 2100. The Spanish Renal Disease Registry (REER) records the incidence, prevalence and mortality of all patients requiring renal replacement therapy (RRT) in Spain.</div></div><div><h3>Methods</h3><div>Data are provided by Spanish autonomous regions and cities and the Organización Nacional de Trasplantes. Incidence and prevalence rates of RRT have been calculated (considering the Spanish population according to annual data from the Instituto Nacional de Estadística), as well as mortality of patients on RRT in our country during the period 2013–2022.</div></div><div><h3>Results</h3><div>The incidence rate of RRT increased by 21% from 2013 to 2019, and stabilized thereafter, with a value of 152.2 cases per million population (pmp) in 2022, of which 77.8% were on haemodialysis (HD), 16.7% on peritoneal dialysis (PD) and 5.5% received a preemptive kidney transplant. Diabetes was the leading cause of CKD requiring RRT (21.8%), followed by other causes (21.6%). The incidence rate of RRT was 2-fold higher in men than in women, with large regional differences (1.93-fold for men and 2.55-fold for women in regions with the highest and lowest incidence rates).</div><div>The prevalence rate of RRT was 1,391.1 pmp in 2022, showing a progressive increase over the last decade, mainly at the expense of an increase in the transplant population (765.0 pmp, 55.0%).</div><div>In 2022, 3,404 kidney transplants were performed in Spain (71.7 pmp), which situates it as a world leader. The most frequent donor type was the donor after the neurological determination of death (51.5%), followed by the donor after the circulatory determination of death (37%).</div><div>The overall annual mortality of RRT patients was 8.4% (13.8% for HD, 10.1% for PD and 3.9% for transplantation).</div></div><div><h3>Conclusions</h3><div>Although it has stabilized somewhat in recent years, the incidence and prevalence of RRT continues to rise in Spain. Additional measures must be adopted to harmonize and optimize kidney health care.</div></div>","PeriodicalId":31770,"journal":{"name":"Nefrologia English Edition","volume":"45 4","pages":"Pages 312-328"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774464","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":"Castleman disease and kidney disease: Are we talking about causality? Review of a series of cases","authors":"Gloria García Conejo ,&nbsp;Ana María Romera Segorbe ,&nbsp;Lucía González López ,&nbsp;Pedro Fernández Migallón Pacheco ,&nbsp;Sara Anaya Fernández ,&nbsp;Paz Castro Fernández ,&nbsp;Luis Javier Yuste Domínguez","doi":"10.1016/j.nefroe.2025.03.006","DOIUrl":"10.1016/j.nefroe.2025.03.006","url":null,"abstract":"<div><div>Castleman's disease is a rare lymphoproliferative disorder of uncertain etiology. There are 3 histopathological patterns with different clinical manifestations, from localized adenopathies and benign clinical course to systemic manifestations of worse prognosis and high risk of developing into malignant processes.</div><div>The following are cases of Castleman's disease with renal involvement treated in the Nephrology Service of the General University Hospital of Ciudad Real, between 2017 and 2024. We describe the clinical evolution and therapeutic management of each of them.</div></div>","PeriodicalId":31770,"journal":{"name":"Nefrologia English Edition","volume":"45 4","pages":"Pages 337-343"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781513","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":"Healthcare models, quality indicators and quality of care in the management of patients with chronic kidney disease in Spain: Results from the CARABELA-CKD initiative","authors":"Mercedes Salgueira ,&nbsp;Pedro Ruiz ,&nbsp;Jesús Ignacio Diago ,&nbsp;CARABELA-CKD Scientific Committee ,&nbsp;Manuel Pérez Maraver","doi":"10.1016/j.nefroe.2025.04.001","DOIUrl":"10.1016/j.nefroe.2025.04.001","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Chronic kidney disease (CKD) poses a significant public health challenge worldwide and its prevalence is rising due to aging populations and increasing risk factors. The CARABELA-CKD initiative aims to address CKD management inefficiencies.</div></div><div><h3>Materials and methods</h3><div>The CARABELA-CKD initiative was structured into four phases. The methodology involved five pilot center studies, conducted to characterize CKD healthcare models (Phase 1), followed by the validation of disease care models, improvement areas, potential solutions, and strategic healthcare quality indicators in a National Multidisciplinary Workshop (Phase 2). Regional meetings were then held to refine all these aspects from a regional perspective and to determine the cocreation of solutions with subsequent quantitative validation of results using the two-round Delphi method (Phase 3B). Dissemination and implementation included integrating findings into digital questionnaires creating digital Playbooks and organizing local workshops (Phase 4).</div></div><div><h3>Results</h3><div>The study identified three CKD care models in Spanish hospitals, each with distinct levels of specialization and resource availability. Twenty-five healthcare quality indicators were validated in a national meeting to assess various aspects of care quality and transformation. Improvement areas were identified, leading to the formulation of solutions to enhance CKD care models in Spain.</div></div><div><h3>Conclusions</h3><div>The CARABELA-CKD initiative, a collaborative effort between Scientific Societies involved in the CKD care process and AstraZeneca, is a nationwide attempt in Spain to create a framework to promote solutions in healthcare delivery and improvements in the quality of care that result in better health outcomes and higher standards of care quality, improved quality of life for patients, and increased efficiency of the Healthcare Service.</div></div>","PeriodicalId":31770,"journal":{"name":"Nefrologia English Edition","volume":"45 4","pages":"Pages 285-293"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873333","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":"Implementation of the in-house technique for the determination of donor-derived cell-free DNA in daily clinical practice: Experience from the Hospital Clinic of Barcelona","authors":"Elena Cuadrado-Payán ,&nbsp;Eva González-Roca ,&nbsp;Diana Rodríguez-Espinosa ,&nbsp;Alicia Molina-Andújar ,&nbsp;Enrique Montagud-Marrahi ,&nbsp;Carolt Arana ,&nbsp;Angela González-Rojas ,&nbsp;Nuria Esforzado ,&nbsp;Vicens Torregrosa ,&nbsp;Pedro Ventura-Aguiar ,&nbsp;María Argudo ,&nbsp;Daniel Serrano-Jorcano ,&nbsp;Maria José Ramírez-Bajo ,&nbsp;Elisenda Bañón-Maneus ,&nbsp;Silvia Casas ,&nbsp;José Jesus Broseta ,&nbsp;Joan Anton Puig-Butille ,&nbsp;Ignacio Revuelta ,&nbsp;Fritz Diekmann ,&nbsp;David Cucchiari","doi":"10.1016/j.nefroe.2025.03.004","DOIUrl":"10.1016/j.nefroe.2025.03.004","url":null,"abstract":"<div><h3>Background and objective</h3><div>The introduction of donor-derived free DNA (ddcfDNA) has emerged as an accurate non-invasive biomarker to diagnose rejection, compared to classical ones. Here we evaluate our experience after its implementation in our center as an in-house technique.</div></div><div><h3>Materials and methods</h3><div>Single-center cross-sectional study with extraction of cell-free DNA in blood and quantification of the ddcfDNA using the AlloSeqcfDNA assay (CareDx) at the time of performing biopsies ‘per protocol’ or ‘per indication’ between December 2020 and December 2023.</div></div><div><h3>Results</h3><div>172 graft biopsies were included (59 for protocol and 113 for cause) in 112 kidney transplant recipients. Among the biopsies, 19 borderline rejections, 11 T-cell mediated rejections, and 30 antibody-mediated rejections were identified. The median ddcfDNA in each diagnostic group was: 0.40% (0.23%–0.82%) in borderline, 0.60% (0.23%–1.91%) in cellular, and 1.48% (0.77%–3.4%) in antibody-mediated rejection (<em>P</em> &lt; .001). In the 112 biopsies with no signs of rejection, the median ddcfDNA was 0.33% (0.17%–0.54%) (<em>P</em> &lt; .001). Cases with positive DSAs and rejection showed higher levels of ddcfDNA than positive DSAs without rejection (<em>P</em> = .010), and ddcfDNA levels were significantly associated with microvascular inflammation and C4d positivity. The area under the ROC curves of ddcfDNA to discriminate any type of rejection from the absence of rejection was 0.74 (0.65−0.82) and, excluding borderline rejection from the analysis, 0.80 (0.72−0.89), outperforming other markers of renal function.</div></div><div><h3>Conclusions</h3><div>Implementing ddcfDNA analysis at our center as a clinical tool has proven valuable for distinguishing biopsy-confirmed acute rejection, particularly antibody-mediated rejection, outperforming classic renal function markers. Its hospital-based implementation supports timely and accurate diagnosis, improving transplant management and prognosis.</div></div>","PeriodicalId":31770,"journal":{"name":"Nefrologia English Edition","volume":"45 4","pages":"Pages 294-301"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873334","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}