American Journal of Nephrology最新文献

{"title":"Association between Systemic Inflammation and Worsening Renal Function in Cardiovascular-Kidney-Metabolic Syndrome.","authors":"Sunying Wang, Jilang Zeng, Yan Chen, Fuqing Sun, Hanghao Ma, Liwei Zhang, Zhijie Lin, Changxi Wang, Yuwei Wang, Qingyong Yang, Manqing Luo, Kaiyang Lin, Yansong Guo","doi":"10.1159/000546130","DOIUrl":"10.1159/000546130","url":null,"abstract":"<p><strong>Introduction: </strong>As a concept recently proposed by the American Heart Association (AHA), cardiovascular-kidney-metabolic (CKM) syndrome is characterized by the interplay of cardiovascular, renal, and metabolic dysfunctions. However, previous studies constantly focused on the cardiovascular outcomes, and there is scarce evidence addressing the association between chronic systemic inflammation and long-term changes in kidney function in the progression of CKM syndrome. This study aimed to investigate the association between the systemic inflammation and worsening renal function (WRF) in individuals with CKM syndrome.</p><p><strong>Methods: </strong>A cohort of 39,944 outpatients with regular follow-up visits at Fuqing City Hospital from 2014 to 2021 was analyzed. WRF was defined as an absolute increase in serum creatinine of ≥26.5 μmol/L (≥0.3 mg/dL) with a relative increase of ≥25% from baseline during the first year of follow-up. Three logistic regression models were constructed to evaluate the associations between systemic immune inflammation index (SII), systemic inflammatory response index (SIRI), and WRF. Restricted cubic spline (RCS) regression was utilized to illustrate the relationship between SII, SIRI, and WRF. Additionally, we explored this correlation through segmented linear regression as part of our threshold analysis.</p><p><strong>Results: </strong>A total of 10,361 individuals (25.9%) experienced WRF within the first year. Higher levels of SII and SIRI were significantly associated with increased odds of WRF across all CKM stages. After adjusting for multiple conventional variables, SII remained an independent predictor for WRF (OR: 1.298, 95% CI: 1.181-1.427, p < 0.001). Similarly, SIRI also demonstrated a significant positive correlation with WRF (OR: 1.026, 95% CI: 1.021-1.030, p < 0.001). The RCS analysis also revealed a dose-response relationship, indicating higher quartiles of SII and SIRI correlating with greater odds of WRF. Further analysis revealed significant interactions between SII, SIRI, and CKM stages, particularly at stages 4 (p < 0.001 for both). Subgroup analysis suggested that this association between SII, SIRI, and WRF was more prominent in the early stage of CKM. The threshold effect analysis demonstrated that for ln transformed SII, a threshold of above 5.565 indicated significant correlation with WRF (OR: 1.277), while for SIRI, the threshold of 2.34 showed a strong correlation below it (OR: 1.330).</p><p><strong>Conclusion: </strong>Both SII and SIRI were associated with the risk of WRF in individuals with CKM. This association seemed more prominent in the early stage of CKM.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-11"},"PeriodicalIF":4.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paraneoplastic Glomerulopathies: Mechanistic and Pathogenic Insights.","authors":"Virginie Royal, Nelson Leung, Sabine Karam, Frank Bridoux, Samih H Nasr","doi":"10.1159/000546050","DOIUrl":"10.1159/000546050","url":null,"abstract":"<p><strong>Background: </strong>Paraneoplastic glomerular diseases are triggered by substances secreted by tumor cells, such as tumor antigens, rather than direct tumor invasion.</p><p><strong>Summary: </strong>These conditions frequently manifest as glomerular disorders, particularly in the elderly, with membranous nephropathy being the most observed lesion. They often present with proteinuria, hematuria, and/or varying levels of kidney dysfunction. In some cases, the initial presentation may precede the diagnosis of malignancy and can be indistinguishable from the idiopathic glomerulopathies, requiring a high level of clinical suspicion to accurately identify a paraneoplastic origin. Although the exact pathophysiologic mechanisms underlying paraneoplastic glomerulopathy are not fully understood, they are thought to involve an immune-mediated response to tumor antigens in most cases.</p><p><strong>Key message: </strong>Recognizing paraneoplastic glomerulopathies is of significant clinical importance as their management is distinct and has substantial implications for the treatment of the associated malignancy.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-13"},"PeriodicalIF":4.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Changes in Peritoneal Transport and Their Impact on Dialysis Outcomes: A Machine Learning Approach Integrating Clinical and Biomarker Data.","authors":"Chia-Chun Lee, Jo-Yen Chao, Kuan-Hung Liu, Wei-Ren Lin, Te-Hui Kuo, An-Bang Wu, Ming-Cheng Wang, Sheng-Hsiang Lin, Chin-Chung Tseng","doi":"10.1159/000545943","DOIUrl":"10.1159/000545943","url":null,"abstract":"<p><strong>Introduction: </strong>Longitudinal changes in peritoneal transport patterns and the predictive role of dialysate biomarkers remain poorly understood. This study assessed the impact of peritoneal equilibration test (PET) trajectory changes on clinical outcomes, explored biomarker contributions, and developed a machine learning-based model to predict peritoneal transport transitions.</p><p><strong>Methods: </strong>This prospective study enrolled peritoneal dialysis (PD) patients aged ≥18 years from 2016 to 2017, with follow-up until 2020. Patients with missing PET data or acute illness within 2 months of PET were excluded. Based on longitudinal PET changes, patients were classified into four trajectory groups: persistent high (HH), high to low (HL), low to high (LH), and persistent low (LL). Clinical outcomes included technique failure and mortality. Dialysate biomarkers were quantified using ELISA and standardized by appearance rates (ARs). A Support Vector Machine (SVM) model was developed to predict PET trajectory changes using clinical and biomarker data. Model performance was assessed using accuracy, precision, recall, F1-score, and area under the curve (AUC).</p><p><strong>Results: </strong>Among 132 eligible patients, cumulative risk analysis identified the HH group as having the highest risk of adverse outcomes, followed by LH, LL, and HL groups (p = 0.009). Based on prognostic trends, HH and LH were reclassified as the future high (FH) group, while HL and LL were grouped as the future low (FL) group. The FH group had a significantly higher risk of adverse outcomes than the FL group (HR: 7.87, 95% CI: 1.81-34.10, p = 0.005). Matrix metalloproteinase 2 (MMP2) AR and plasminogen activator inhibitor 1 (PAI-1) AR differed significantly across PET trajectory groups (p < 0.001 for both), with the HH group exhibiting the highest biomarker levels (MMP2 AR: 195.0 ng/min, IQR: 145.2-230.0; PAI-1 AR: 2.63 ng/min, IQR: 1.29-4.51). The SVM model integrating clinical and biomarker data outperformed models using clinical data alone, achieving a higher AUC (0.87 vs. 0.71). Risk visualization curves identified males with elevated biomarkers as particularly vulnerable to transitioning to high transporter status.</p><p><strong>Conclusions: </strong>Sustained or transitioning to a high transporter status significantly increases the risk of adverse outcomes in PD patients. Higher MMP2 AR and PAI-1 AR levels are associated with an increased risk of adverse PET trajectory changes, enhancing risk stratification. Integrating biomarker-based predictive models with clinical data improves prognostic accuracy, supporting early intervention strategies for high risk patients.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-14"},"PeriodicalIF":4.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neutrophil Percentage-to-Albumin Ratio as a Predictor of Acute Kidney Injury in Cirrhotic Patients: A Novel Approach Utilizing Artificial Intelligence.","authors":"Nasser Mousa, Sherif Elbaz, Alaa Elmetwalli, Mostafa Abdelsalam, Eman Abdelkader, Mohamed Wahba, Mohammed Abdelaziz, Ola El-Emam, Niveen El-Wakeel, Mohamed Shaheen, Badawy Abo-Bakr, Muhammad Diasty, Naglaa Abbas, Mohamed Selim, Marwa Mansour","doi":"10.1159/000545639","DOIUrl":"10.1159/000545639","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) is common in cirrhotic patients and is associated with a poor prognosis. The neutrophil percentage-to-albumin ratio (NAR) is a novel marker of systemic inflammation. This study aimed to evaluate the predictive power of NAR for AKI in cirrhotic patients with ascites using AI tools such as Shapley Additive Explanations and a Random Forest (RF) model.</p><p><strong>Methods: </strong>This study involved 322 patients with liver cirrhosis and ascites. AKI was defined based on the International Club of Ascites. The sensitivity and specificity of the NAR were evaluated using receiver operating characteristic curve analysis. Predictors of AKI were identified, and the significance of artificial intelligence features was determined using Shapley Additive Explanations. The RF model was utilized to rank all predictors for AKI.</p><p><strong>Results: </strong>In our study, 130 patients (40.3%) developed AKI, with stages 2 and 3 analyzed for clinical relevance. The NAR at a cutoff of >23.2 revealed a substantial predictive value for AKI stages 2 and 3 (AUC = 0.893, sensitivity = 85.4%, specificity = 72.3%). The RF model identified serum albumin as the top predictor with an importance score of 0.350, followed by NAR with a score of 0.280, and chronic kidney disease ranked third with a score of 0.170. These factors are key drivers in predicting the outcome of AKI. Age, ischemic heart disease, diabetes mellitus, international normalized ratio, and hemoglobin had lower predictive power.</p><p><strong>Conclusion: </strong>NAR could be a new, affordable, and non-invasive test demonstrating a strong discriminative ability to predict AKI in cirrhotic patients.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-13"},"PeriodicalIF":4.3,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glomerular Basement Membrane Thickness Estimation and Stratification via Active Semi-Supervised Learning Model.","authors":"Nico Curti, Gianluca Carlini, Sabrina Valente, Enrico Giampieri, Alessandra Merlotti, Daniel Remondini, Gaetano La Manna, Gastone Castellani, Gianandrea Pasquinelli","doi":"10.1159/000542658","DOIUrl":"10.1159/000542658","url":null,"abstract":"<p><strong>Introduction: </strong>The measure of glomerular basement membrane (GBM) thickness is used as diagnostic criteria for kidney glomerular diseases. The GBM thickness measurement, a time-consuming task, is performed by expert pathologists on transmission electron microscopy (TEM) images; therefore, it is affected by subjectivity and reproducibility issues.</p><p><strong>Methods: </strong>Here we introduce a fully automated pipeline for the GBM segmentation and successive thickness estimation, starting from TEM images. This method is based on an active semi-supervised learning training procedure of a convolutional neural network model. Starting from the areas automatically identified by the model, we provide a robust measurement of membrane thickness using pixels distance matrix and computer vision techniques. Using these values, we trained a machine learning model to automatically determine the GBM thickness. To verify the accuracy of the method, we compared the predicted results with the full iconographic materials and diagnostic record reports from 42 renal biopsies having normal thickness (n = 21), thin (n = 10), thick GBM (n = 11).</p><p><strong>Results: </strong>The obtained segmentations were used for the automated estimation of GBM thickness via computer vision algorithms and compared with manual measurements, obtaining a correlation of Pearson's R2 of 0.85. The GBM thickness was stratified into 3 classes, namely, normal, thin, thick, with a 0.63 Matthews correlation coefficient and a 0.76 accuracy.</p><p><strong>Conclusion: </strong>The proposed pipeline obtained state-of-the-art performance in GBM segmentation, proving its robustness under image variations, such as magnification, contrast, and complex geometrical shapes. Automated measures could assist clinicians in standard clinical practice speeding up routine procedures with high diagnostic accuracy.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-14"},"PeriodicalIF":4.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrolytes Abnormalities in Cancer Patients.","authors":"Arash Rashidi, Nada Youssef, Biruh Workeneh, Alex Carsel, Victoria Gutgarts, Sheron Latcha","doi":"10.1159/000544877","DOIUrl":"10.1159/000544877","url":null,"abstract":"<p><strong>Background: </strong>Electrolyte disorders are common in cancer patients and have significant impacts on treatment outcomes and quality of life. The frequency, severity, complexity, and etiology of fluid and electrolyte disorders are different among cancer patients when compared to the general population.</p><p><strong>Summary: </strong>This review describes the key electrolyte imbalances and pathogenesis, including sodium disorders, potassium disorders, and abnormalities in magnesium, calcium, and phosphorus levels, within the context of cancer therapies. Cancer-specific therapies reviewed surgical and radiologic therapies, cellular therapies, use of checkpoint inhibitors, and traditional cytotoxic chemotherapy that can result in specific patterns of electrolyte derangements.</p><p><strong>Key message: </strong>The objective of this article is to highlight clinical presentations and to discuss management of some cancer-specific electrolyte disturbances. This article underscores the importance of regular electrolyte monitoring and timely intervention in managing cancer patients.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-16"},"PeriodicalIF":4.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunotherapy and Cellular Therapies for Cancers in Kidney Transplant Patients.","authors":"Massini Merzkani, Rose Mary Attieh, Kenar D Jhaveri, Naoka Murakami","doi":"10.1159/000544826","DOIUrl":"10.1159/000544826","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplant is the treatment of choice for end-stage kidney disease, with longer survival and better quality of life posttransplant. However, long-term immunosuppression comes with an increased risk of cancer and infection. Cancer is one of the leading causes of death after kidney transplant. While novel cancer therapies become available, transplant recipients are usually excluded from clinical trials.</p><p><strong>Summary: </strong>In this review, we summarize the updated knowledge on immunosuppression management in kidney transplant recipients treated with immune checkpoint inhibitors (ICIs), bispecific T-cell engager therapy, and chimeric antigen receptor (CAR)-T-cell therapies.</p><p><strong>Key messages: </strong>Transplant nephrologists should be empowered to participate in the decision-making of cancer treatment together with patients, care partners, and oncologists, by managing immunosuppression.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-14"},"PeriodicalIF":4.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune Checkpoint Inhibitor-Related Acute Kidney Injury: Management and Challenges.","authors":"Nada Youssef, Ala Abudayyeh","doi":"10.1159/000543323","DOIUrl":"10.1159/000543323","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) have been increasingly used over the past decade for treatment of several cancer types. Despite the excellent cancer response they provide, their use has been associated with serious immune-related adverse events affecting multiple systems including the kidney. Currently, limited data are available to guide treatment of acute kidney injury secondary to ICI use (ICI-AKI) due to tubulointerstitial nephritis or glomerulonephritis. Another huge obstacle is the safety of resuming ICI following an episode of ICI-AKI.</p><p><strong>Summary: </strong>Acute tubulointerstitial nephritis (ATIN) is the most common pathology associated with ICI-AKI, followed by other less common forms of glomerulonephritis. Management of this disorder is very challenging. Corticosteroids therapy remains the mainstay treatment for patients with ICI-ATIN. Use of other immunosuppressants for ICI-ATIN and recurrent ICI-ATIN has been also described in the literature. In patients with ICI-related glomerulonephritis, the use of rituximab is the more common approach reported in the literature. Regarding the safety to resume ICI following an episode of ICI-AKI, this decision should be made following a multidisciplinary approach on a case-by-case basis.</p><p><strong>Key messages: </strong>Limited evidence is available to guide management in patients with ICI-AKI. More prospective studies are needed in the future to better guide treatment of cancer patients with ICI-AKI.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-12"},"PeriodicalIF":4.3,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Implementation of Nephrologist-Led Genomic Testing for Glomerular Diseases in Singapore: Rationale and Protocol.","authors":"Cynthia Lim, Ru Sin Lim, Jason Choo, Esther Huimin Leow, Gek Cher Chan, Yaochun Zhang, Jun Li Ng, Hui-Lin Chin, Ee Shien Tan, Jeannette Goh, Naline Gandhi, Yong Hong Ng, Mya Than, Indra Ganesan, Siew Le Chong, Celeste Yap, Sing Ming Chao, Breana Cham, Sylvia Kam, Jiin Ying Lim, Irene Mok, Hui Zhuan Tan, Jia Liang Kwek, Tung Lin Lee, Ziyin Wang, Su Mein Goh, Regina Lim, See Cheng Yeo, Boon Wee Teo, Yi Da, David Matchar, Kar Hui Ng","doi":"10.1159/000542942","DOIUrl":"10.1159/000542942","url":null,"abstract":"<p><strong>Introduction: </strong>The early diagnosis and appropriate treatment of monogenic glomerular diseases can reduce kidney failure, avoid unnecessary investigations such as kidney biopsies and ineffective treatment with immunosuppressants, guide transplant decisions, and inform the genetic risks of their family members. Yet, genetic testing for kidney disease is underutilized in Singapore. We aimed to implement a nephrologist-led genetic service and evaluate the acceptance, adoption, utility, and cost-effectiveness of genetic testing for monogenic glomerular disease in Singapore.</p><p><strong>Methods: </strong>We will perform a prospective, multi-centre, type II hybrid effectiveness-implementation study with a post-design to evaluate both implementation and clinical outcomes of nephrologist-led genetic testing for suspected genetic glomerular kidney diseases. The multi-disciplinary implementation team will train \"genetic nephrologists\" to provide pre- and post-test counselling, order targeted exome panel sequencing for suspected glomerular kidney diseases (persistent microscopic haematuria and/or albuminuria or proteinuria in the absence of known causes, steroid-resistant primary nephrotic syndrome, apparent familial IgA nephropathy, or chronic kidney disease with no apparent cause), and interpret genetic test results; create workflows for patient referral, evaluation and management, and discuss genetic results at regular genomic board meetings. The outcomes are acceptance, appropriateness and adoption among patients and nephrologists, utility (proportion of patients who received genetic testing and have a confirmed diagnosis of genetic glomerular disease), and cost-effectiveness.</p><p><strong>Conclusion: </strong>This study will create and evaluate a nephrologist-led genetic service, develop an efficient variant curation process, and inform future recommendations on the optimal referral and genetic testing strategy for monogenic glomerular disease in Singapore. This will facilitate the future mainstreaming of genetic testing that will enable precision medicine in kidney care.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"158-171"},"PeriodicalIF":4.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765481","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":"Impact of Peritoneal Neutrophil Extracellular Traps on Peritoneal Characteristics and Technical Failure in Patients Undergoing Peritoneal Dialysis.","authors":"Insoo Kim, Sei Hong Min, Hoi Woul Lee, Jung Nam An, Hyung Seok Lee, Sung Gyun Kim, Jwa-Kyung Kim","doi":"10.1159/000542427","DOIUrl":"10.1159/000542427","url":null,"abstract":"<p><strong>Introduction: </strong>Peritoneal dialysis (PD) is an effective home therapy for end-stage kidney disease. However, continuous exposure to PD fluids with high glucose concentration and recurrent peritonitis may lead to the activation of cellular and molecular processes of peritoneal damage, including inflammation and fibrosis. In particular, recent studies have highlighted the role of neutrophils in chronic inflammation. This study explores how neutrophil extracellular traps (NETs) affect peritoneal membrane function and contribute to technical failures in PD patients.</p><p><strong>Methods: </strong>We conducted a prospective observational study involving 250 noninfectious and 30 acute peritonitis patients. NETs were measured using nucleosome and myeloperoxidase DNA levels in PD fluids. Monocyte chemoattractant protein-1 (MCP-1) and matrix metalloproteinase-8 (MMP-8) were also measured to assess peritoneal inflammation and damage.</p><p><strong>Results: </strong>A significant increase in peritoneal NETs, as determined by nucleosome and myeloperoxidase DNA levels, was observed in patients with acute peritonitis compared to patients without peritonitis. Even in noninfectious samples, NET levels were widely distributed and closely correlated with levels of MCP-1 and MMP-8. Higher levels of peritoneal NETs were closely associated with increased 4-h dialyzate/peritoneal (D/P) creatinine ratio and 1-h D/P sodium levels, indicating a higher prevalence of fast transport and limited free water transport. These factors were associated with a higher risk of technical failure. During a mean follow-up of 34 months, 39.2% (98 patients) switched from PD to hemodialysis, with higher NET levels significantly increasing the risk by 1.9 times (95% confidence interval: 1.27-2.83, p = 0.020).</p><p><strong>Conclusion: </strong>This study suggests the importance of peritoneal NETs not only as markers of acute inflammation but also as significant immunological predictors of chronic peritoneal membrane inflammation and dysfunction and as potential risk factors for technical failure.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"136-147"},"PeriodicalIF":4.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}