Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association最新文献

{"title":"Trends in nephrology: From \"diabetic kidney disease\" to \"CKD with risk factor diabetes\".","authors":"Marijn M Speeckaert, Peter Rossing","doi":"10.1093/ndt/gfaf134","DOIUrl":"https://doi.org/10.1093/ndt/gfaf134","url":null,"abstract":"","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639597","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":"Acute post-streptococcal glomerulonephritis in children - treatment standard.","authors":"Ajaya Kumar Dhakal, Devendra Shrestha, Rebecca Preston, Rachel Lennon","doi":"10.1093/ndt/gfaf130","DOIUrl":"https://doi.org/10.1093/ndt/gfaf130","url":null,"abstract":"<p><p>Acute post-streptococcal glomerulonephritis is the leading cause of acute glomerulonephritis in children worldwide, owing to the high incidence of nephritogenic strains of group A beta-haemolytic streptococcal throat and skin infections. The incidence of acute post-streptococcal glomerulonephritis is declining in developed countries because of better access to clean drinking water, enhanced sanitation, and improved hygiene. However, it remains a public health problem and a significant cause of hospitalisation in low-income and middle-income countries. The pathogenesis of acute post-streptococcal glomerulonephritis involves the activation of the alternate complement pathway mediated by immune complexes, resulting in glomerular inflammation and subsequent kidney injury. The disease characteristically presents with features of acute nephritic syndrome and occasionally with complications such as hypertensive emergencies, congestive cardiac failure, nephrotic syndrome, severe acute kidney injury, and rapidly progressive glomerulonephritis. Preventing streptococcal throat and skin infections, early diagnosis and identification of complications, and prompt initiation of treatment are the cornerstones of acute post-streptococcal glomerulonephritis management and recovery. Treatment primarily consists of supportive care along with diuretics and antihypertensive therapy, while only a small number of patients require immunosuppressants or kidney replacement therapy. Kidney biopsies are seldom required to guide subsequent treatment, particularly in cases of diagnostic uncertainty, rapidly progressive glomerulonephritis, or atypical disease progression. Most patients make a full recovery from the disease. However, persistent proteinuria, hypertension, and progression to chronic kidney disease may require long-term monitoring. Here, we review current treatment standards and discuss novel developments in the pathophysiology, diagnosis, outcome prediction, and management of acute post-streptococcal glomerulonephritis in children.</p>","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621754","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":"Peptide Receptor Radionuclide therapy: A New Era of Radiation Nephropathy.","authors":"Abhirami Das, Ayse Tuba Kendi, Sandhya Manohar","doi":"10.1093/ndt/gfaf121","DOIUrl":"https://doi.org/10.1093/ndt/gfaf121","url":null,"abstract":"<p><p>Peptide Receptor Radionuclide Therapy (PRRT) has transformed the management of neuroendocrine tumors and other malignancies by enabling targeted radiation delivery while minimizing systemic toxicity. However, incidental renal radiation exposure presents a significant risk of radiation nephropathy, and this risk varies based on the unique characteristics of the radionuclide and its decay phenomenon as well as the peptide being utilized. This review explores the historical development of PRRT, the physics of radionuclide therapy as necessary for a practicing nephrologist, and key mechanisms of radiation related kidney injury. We detail renal handling of radionuclides, dose thresholds, and pathological features of PRRT-induced nephropathy. Furthermore, we discuss both current and prospective strategies to reduce renal toxicity-such as amino acid infusions, receptor saturation, cleavable linkers, and emerging protective agents. Special considerations for PRRT in patients with chronic kidney disease and those on dialysis are highlighted. As PRRT applications expand, multidisciplinary collaboration is essential to optimize renal safety.</p>","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602809","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":"Risk-based referral model to nephrologist-specialist care in Stockholm.","authors":"Aurora Caldinelli, Anne-Laure Faucon, Arvid Sjölander, Roosa Lankinen, Antoine Creon, Edouard L Fu, Marie Evans, Juan Jesus Carrero","doi":"10.1093/ndt/gfaf128","DOIUrl":"https://doi.org/10.1093/ndt/gfaf128","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>For most patients, clinical management of early stages of CKD is performed in primary care settings. KDIGO 2024 guidelines recommended using a 5-year kidney failure risk equation (KFRE) of 3-5% to guide nephrologist referrals. Here, we aimed to assess the impact of adopting a risk-based referral model compared to traditional referral criteria.</p><p><strong>Methods: </strong>Observational retrospective study of adults with eGFR < 60 mL/min/1.73m² (Lund-Malmö equation) from the SCREAM project, a healthcare utilization cohort from Stockholm, Sweden. We evaluated the performance of the Non-North American 4-variable KFRE and recalibrated it to better fit our setting. KFRE thresholds were compared with traditional models: the clinical Swedish criteria and the classic KDIGO 2012 criteria, both of which are mainly based on age, eGFR and albuminuria thresholds. Sensitivity, specificity, positive, negative predictive values, reclassification matrices, net reclassification improvement, and decision curve analyses were used to assess performance and clinical utility.</p><p><strong>Results: </strong>The study included 887 388 observations from 192 964 individuals. At inclusion, 49% were men, median age was 76 years and median eGFR 54 mL/min/1.73m2. During follow-up, 2 624(1.4%) progressed to KRT. KFRE demonstrated a good prediction performance, further improved after recalibration. Both Non-North American and SCREAM recalibrated KFRE provided higher sensitivity and specificity than Swedish and classical KDIGO criteria. KFRE-based referral models yielded better net reclassification improvement, demonstrating superior performance in decision curve analyses. Higher thresholds (15% for the Non-North American KFRE, 9% for the SCREAM recalibrated KFRE) than the KDIGO recommended ones provided the best combined sensitivity and specificity. Compared with traditional referral models, implementation of a risk-based referral would decrease the number of unnecessary referrals by 23% and 25%, respectively.</p><p><strong>Conclusion: </strong>In a large north-European healthcare system, transitioning to a risk-based referral model would result in an important reduction of unnecessary referrals while maintaining a low rate of missed cases, optimizing resource utilization.</p>","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593719","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":"Effect of haemodialysis on the brain and heart assessed using multiparametric MRI.","authors":"Eleanor F Cox, Venkata Rukmini Latha Gullapudi, Charlotte E Buchanan, Kelly White, Rosemary Nicholas, Bernard Canaud, Maarten W Taal, Nicholas M Selby, Susan T Francis","doi":"10.1093/ndt/gfaf117","DOIUrl":"https://doi.org/10.1093/ndt/gfaf117","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Haemodialysis (HD) patients often develop cognitive impairment, negatively impacting health-related quality of life. We use brain magnetic resonance imaging (MRI) measures to study the acute changes in cerebral water content during HD, alongside chronic changes in HD patients compared to healthy volunteers (HV) to assess whether the brain changes associated with ageing develop more rapidly in HD patients ('accelerated brain ageing'). We also study associated cardiac MRI measures.</p><p><strong>Methods: </strong>3T MRI scans were performed during HD in 12 patients to characterise the acute effect of HD on cerebral water content (T1 mapping), alongside previously reported results from the HD-REMODEL trial. MRI changes in brain structure (volumes and T1 of white (WM) and grey matter (GM), WM diffusion fractional anisotropy (FA) and mean diffusivity (MD)), perfusion, blood flow, and cardiac measures were compared between HD patients pre-dialysis and HVs (age and gender matched).</p><p><strong>Results: </strong>WM T1 increased during HD (3.8 ± 1.7%, p = 0.0005). GM and WM volume (total intracranial volume (TIV)-corrected) were lower in HD compared to HVs (GMV/TIV: 0.37[0.34-0.41] vs. 0.42[0.42-0.44], WMV/TIV: 0.34 ± 0.03 vs. 0.37 ± 0.01, p = 0.009). In HD, FA was lower and MD higher than HV (FA: 0.32 ± 0.02 vs. 0.35 ± 0.01, MD: 0.59 ± 0.03 vs. 0.53 ± 0.01, p < 0.0001).. Higher MD and lower FA was seen in older participants, with steeper slopes in HD (MD: 0.003 vs. 0.0006 × 10-3 mm2/s/y p = 0.003, FA: -0.001 vs -0.0003 units/y p < 0.0001), suggestive of accelerated ageing. There were no differences between groups in age-related heart changes.</p><p><strong>Conclusions: </strong>An acute increase in WM T1 during HD has been shown for the first time, reflecting a rise in brain water content. This is potentially caused by the development of an osmotic gradient across the blood-brain barrier due to slower diffusion of urea, and may contribute to acute symptoms and chronic pathological changes contributing to accelerated brain ageing in HD patients.</p>","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593718","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":"Cost-Effectiveness of a Ketoanalogue-supplemented Very Low-protein Diet in CKD.","authors":"Povero Massimiliano, Simion Tatiana, Lorenzo Pradelli","doi":"10.1093/ndt/gfaf123","DOIUrl":"https://doi.org/10.1093/ndt/gfaf123","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a global health concern with significant economic implications, particularly in the management of end-stage renal disease, which often requires kidney replacement therapy such as dialysis or transplantation. The rising incidence of ESRD is expected to increase healthcare costs substantially by 2030. Dietary protein restriction is a cornerstone of managing CKD progression, and the use of ketoanalogues in very low-protein diets (VLPD) has shown promise in delaying dialysis initiation. This study evaluates the cost-effectiveness of a vegetarian ketoanalogue-supplemented VLPD (s-VLPD) compared to a low-protein diet (LPD) in patients with CKD stages 4 and 5 in Italy.</p><p><strong>Methods: </strong>A Markov model was developed to simulate the health outcomes and costs for patients with CKD stages 4 or 5, treated with either s-VLPD or LPD. The analysis was conducted from both the Italian National Healthcare Service (NHS) and societal perspectives. Healthcare costs considered were: ketoanalogue supplementation, dialysis, and diet monitoring. Overall survival and quality-adjusted life years (QALYs) were used as effectiveness outcomes. Sensitivity analyses, including deterministic and probabilistic approaches, assessed the robustness of the results.</p><p><strong>Results: </strong>The s-VLPD strategy led to improved survival (+0.60 years) and increased QALYs (+0.49) compared to LPD, along with cost savings of approximately €34 000 per patient from the NHS perspective. From the societal perspective, s-VLPD resulted in a cost saving of €59 147 per patient. Sensitivity analyses confirmed that s-VLPD remains a dominant strategy, demonstrating both clinical and economic advantages.</p><p><strong>Conclusion: </strong>s-VLPD is a cost-effective strategy for managing CKD stages 4 and 5, offering improved patient outcomes and significant cost savings. The findings support the integration of s-VLPD in routine clinical practice, helping delay dialysis initiation, reduce the financial burden on healthcare systems, and improve patient quality of life.</p>","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586198","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":"Sex-specific clinical presentations and outcomes in ANCA vasculitis presenting with severe kidney disease.","authors":"Marta Casal Moura, Marc Patricio Liebana, Ladan Zand, Dalia Zubidat, Maria J Vargas-Brochero, Daniela Valencia, Miriam Machado, Sana Abouzahir, Ulrich Specks, Sanjeev Sethi, Fernando C Fervenza, Maria José Soler","doi":"10.1093/ndt/gfaf120","DOIUrl":"https://doi.org/10.1093/ndt/gfaf120","url":null,"abstract":"<p><strong>Background: </strong>The impact of sex in the clinical presentation and outcomes of patients with anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis (AAV) with glomerulonephritis (AAV-GN) has not been studied, particularly in patients with severe kidney involvement at presentation (eGFR < 15 mL/min/1.73m2).</p><p><strong>Methods: </strong>A retrospective cohort study on MPO- or PR3-ANCA positive patients with AAV (MPA or GPA) and eGFR<15 ml/min/1.73m2 or end-stage kidney disease (ESKD) at presentation. Clinical presentation and renal outcomes were analyzed according with sex.</p><p><strong>Results: </strong>We analyzed 166 patients with biopsy proven active AAV-GN and eGFR < 15 mL/min/1.73m2 at the time of diagnosis: 78 (47%) were females and 88 (53%) were males. Hypertension was more frequently present in males (85.2% vs.70.5%, P = 0.022). Median serum creatinine (SCr) was higher in males when compared with females (5.2 [IQR 4.2-7.4] vs. 3.6 [IQR 2.8-5.1]mg/dL, P < 0.001). There were no statistically significant differences in the median percentage of crescents. However, the rate of dialysis initiation or progression to ESKD in the first 12 months was not different between males (15, 62.5%) versus females (29, 61.7%) at 12 months. By multivariable logistic regression, factors related with dialysis initiation within the first 4 weeks in our cohort were SCr, alveolar hemorrhage, and PR3-ANCA adjusted for sex.</p><p><strong>Conclusion: </strong>In our cohort, male patients presented with higher SCr, and dialysis was started within the first 4 weeks more frequently (53.4% vs. 30.7%). There were no differences in outcomes of kidney recovery, overall dialysis rates, and progression to ESKD within 12 months in patients with AAV-GN and eGFR < 15 mL/min/1.73m2 between groups.</p>","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586200","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":"Urinary rituximab loss and rate of treatment failure in membranous nephropathy.","authors":"Marco Allinovi, Matteo Accinno, Cecilia Finocchi, Tommaso Mazzierli, Leonardo Caroti, Daniela Lazzarini, Lorenzo Cosmi, Andrea Matucci, Marco Del Carria, Michael Diomaiuti, Calogero Lino Cirami, Francesco Peyronel, Alessandra Vultaggio","doi":"10.1093/ndt/gfaf127","DOIUrl":"https://doi.org/10.1093/ndt/gfaf127","url":null,"abstract":"<p><strong>Background: </strong>Rituximab is a first-line treatment for primary membranous nephropathy, but approximately one-third of patients fail to respond. Among the proposed mechanisms of rituximab resistance, urinary rituximab loss due to non-selective proteinuria could lead to drug underexposure and treatment failure. Although hypothesized, this has never been objectively measured with a practical and reproducible method.</p><p><strong>Methods: </strong>We conducted a prospective, observational study of 25 patients with biopsy-proven primary membranous nephropathy treated with rituximab (two infusions of 1 g, two weeks apart) at Careggi University Hospital, Florence, Italy. Rituximab levels were measured in serum and urine using a commercially available ELISA adapted for urinary samples. Urinary rituximab concentrations were assessed in 60 individuals to identify a threshold below which rituximab is considered not present in urine. Eight non-responders with urinary rituximab ≥2 µg/mL (potentially underexposed) received a second treatment course to test whether a higher rituximab dose would provide benefits in terms of kidney outcomes.</p><p><strong>Results: </strong>Urinary rituximab loss was associated with markers of disease severity, including lower eGFR (r= -0.50; p =0.01), higher proteinuria (r=0.46; p =0.02), and non-selective proteinuria (r=0.61; p =0.001). Patients with urinary rituximab ≥2 µg/mL had lower serum rituximab peak levels at 1 month (p=0.04), possibly reflecting drug underexposure, and significantly lower response rates (43% vs 100%, p=0.003). PLA2R antibody depletion was significantly more frequent in patients with lower urinary rituximab levels (80% vs 17%, p=0.008). In the re-treated subgroup, five of eight non-responders showing significant urinary rituximab loss and receiving a second course of treatment achieved clinical response.</p><p><strong>Conclusions: </strong>In primary membranous nephropathy, urinary rituximab loss is associated with disease severity, drug underexposure, and treatment failure. Measuring urinary rituximab could help identify patients at risk of resistance who could benefit from additional rituximab dosing. This approach could improve outcome prediction and support personalized immunosuppressive strategies.</p>","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586201","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":"Efficacy and safety of balcinrenone and dapagliflozin for CKD: design and baseline characteristics of the MIRO-CKD trial.","authors":"Patrick B Mark, Erika De Sousa-Amorim, Anna L Eriksson, Maria L Zachrisson, Nicolas J Guzman, Matthew T Miller, Yunyun Jiang, Hiddo J L Heerspink","doi":"10.1093/ndt/gfaf119","DOIUrl":"https://doi.org/10.1093/ndt/gfaf119","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Despite benefits of sodium-glucose co-transporter-2 inhibitors (SGLT2i) recommended for treatment of chronic kidney disease (CKD), there is still an unmet need for managing renal residual risk. Based on pre-clinical data, balcinrenone is a novel mineralocorticoid receptor antagonist that maintains cardio-renal benefits without increasing hyperkalaemia risk. Use of balcinrenone and dapagliflozin is expected to provide complementary and additive kidney and cardiovascular protection. The MIRO-CKD study tests the hypothesis that balcinrenone with dapagliflozin is superior to dapagliflozin alone in reducing albuminuria in patients with CKD.</p><p><strong>Methods: </strong>MIRO-CKD is a double-blind, active-controlled, phase 2b study evaluating the efficacy and safety of balcinrenone/dapagliflozin in 300 adults (planned) with CKD, eGFR 25-60 mL/min/1.73m2 and serum potassium within normal range. Participants are being randomized 1:1:1 to balcinrenone/dapagliflozin 15 mg/10 mg, 40 mg/10 mg or placebo/dapagliflozin 10 mg for 12 weeks, followed by an 8-week wash-out period to assess off-drug effects. The primary endpoint is the change in log-transformed urinary albumin-to-creatinine ratio (UACR) from baseline to Week 12. Other outcomes include pharmacokinetics, safety and tolerability.</p><p><strong>Results: </strong>614 patients were screened and 324 were randomized across 15 countries in Asia, Europe, North and South America. 56.2% of participants were taking SGLT2i and 87.1% renin angiotensin aldosterone system inhibitors at enrolment. The patient population are at increased risk of CKD progression by having CKD stage 3/4 and albuminuria (median UACR: 365.5 mg/g; mean eGFR: 42.2 mL/min/1.73m2). 56.5% of participants had type 2 diabetes mellitus.</p><p><strong>Conclusions: </strong>MIRO-CKD is a fully recruited global trial enrolling a contemporary CKD population at increased risk of progression and with an increased risk of hyperkalaemia based on their reduced kidney function. The study will assess the efficacy, safety and tolerability of the combination of balcinrenone and dapagliflozin to identify an optimal dose for a future phase 3 study in patients with CKD.</p>","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586199","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":"Multifactorial chronic kidney disease.","authors":"Jose Manuel Arreola Guerra, Jesus-Israel Martinez-Martinez","doi":"10.1093/ndt/gfaf122","DOIUrl":"https://doi.org/10.1093/ndt/gfaf122","url":null,"abstract":"<p><p>The burden of disease due to chronic kidney disease (CKD) has disproportionately grown in the last decades. This growth has not been similar in all regions. In the last few years, the results of clinical trials, particularly those evaluating sodium-glucose-cotransporter-2 (SGLT2) inhibitors and their efficacy in decreasing cardiovascular mortality and chronic kidney disease progression, revealed the relevance of a common protective pathway that remains non-specific as it has been detected in multiple clinical scenarios. However, the injury pathways in kidney disease are now well-defined in immunological, toxic, and genetic kidney pathologies. Therefore, the multifactoriality of chronic kidney disease is evident. Even prenatally, the number of nephrons is mostly determined by multiple factors that influence the maternal environment, and subsequently, throughout life, various exposures and pathologies gradually reduce the total number of nephrons. A better understanding of CKD as a multifactorial entity requires us to be aware of the primary injury pathways that can play a role throughout our lifetimes and implement more concrete measures to decrease the impact of CKD globally. Due to the heterogeneity of the CKD burden between world regions, local epidemiological studies are essential to understand the factors associated with CKD in each region.</p>","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562647","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}