BMC Nephrology最新文献

{"title":"Sustained potassium control and recurrent hyperkalemia during individualized potassium-guided sodium zirconium cyclosilicate titration in maintenance hemodialysis: a post hoc analysis of a randomized trial.","authors":"Haiming Wang, Wei Zhou, Yan Jiang","doi":"10.1186/s12882-026-05446-3","DOIUrl":"10.1186/s12882-026-05446-3","url":null,"abstract":"<p><strong>Background: </strong>A mean predialysis potassium value at a single visit does not show whether the same patient remains controlled across consecutive months or repeatedly crosses hyperkalemic thresholds. We evaluated sustained patient-level potassium control and recurrent hyperkalemia during individualized potassium-guided sodium zirconium cyclosilicate (SZC) therapy on non-dialysis days.</p><p><strong>Methods: </strong>This exploratory post hoc analysis used data from a previously reported single-center, open-label randomized trial of 116 patients with chronic hyperkalemia (58 per group). The primary outcome was sustained response during months 3-6, which required all four scheduled predialysis potassium measurements after the long interdialytic interval to be available, at least three of the four values to be within 4.0-5.0 mmol/L, and no unplanned hemodialysis triggered by potassium ≥ 6.5 mmol/L during the evaluation period. Missing measurements were classified as nonresponse. Adjusted risk ratios (aRRs) were estimated using modified Poisson regression with robust standard errors.</p><p><strong>Results: </strong>The primary outcome occurred in 25/58 (43.1%) SZC-treated participants and 8/58 (13.8%) controls (aRR 3.02, 95% confidence interval [CI] 1.49-6.14). Sustained response within 4.0-5.5 mmol/L occurred in 38/58 (65.5%) and 22/58 (37.9%), respectively (aRR 1.74, 95% CI 1.19-2.54). At least two scheduled potassium values ≥ 5.5 mmol/L occurred in 11/58 (19.0%) and 36/58 (62.1%) (aRR 0.31, 95% CI 0.18-0.55). The adjusted incidence rate ratio for visits with potassium ≥ 5.5 mmol/L was 0.36 (95% CI 0.24-0.54). Complete-case and conservative extreme-case missing-data analyses were directionally consistent with the main analysis.</p><p><strong>Conclusions: </strong>Individualized potassium-guided SZC therapy was associated with a higher probability of meeting the sustained biochemical potassium-control criterion at scheduled monthly measurements and with fewer recurrent biochemical hyperkalemic excursions. Clinical outcomes were not evaluated in the present analysis; therefore, the observed biochemical improvements should not be interpreted as evidence of clinical benefit.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR2600119050. Registered on 14 February 2026; retrospectively registered.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early integration of palliative care in outpatient nephrology: exploring healthcare professionals' knowledge, attitudes, and communication practices - an exploratory multi-methods study.","authors":"Melanie Joshi, Mareike Löbberding, Jana Grimm, Axel Doll, Steffen T Simon, Raymond Voltz, Linus Völker, Julia Strupp","doi":"10.1186/s12882-026-05409-8","DOIUrl":"10.1186/s12882-026-05409-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Patients with advanced kidney disease often experience high symptom burden and complex illness trajectories, highlighting the importance of integrating palliative care into nephrology. However, palliative care remains insufficiently integrated into routine care within nephrology outpatient centers. This study explored healthcare professionals' (HCPs) perspectives on palliative care integration, including knowledge and confidence in identifying patients with palliative care needs as well as perceived barriers and facilitators to implementation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An explorative multi-methods study was conducted as part of a project aiming to implement a minimally invasive intervention in nephrology outpatient centers in Germany (MINI-Neph). HCPs from participating centers received a one-hour training introducing palliative care in nephrology, communication strategies for emotionally challenging situations, and using two validated tools for identifying patients with palliative care needs: the Surprise Question (SQ) and the Supportive and Palliative Care Indicators Tool (SPICT-DE). Data were collected through an online survey, free-text responses and semi-structured interviews with HCPs and analyzed using descriptive statistics and qualitative content analysis, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Five nephrology outpatient centers located in different regions across Germany were involved in the MINI-Neph-Study. A total of 52 HCPs participated; most were female (82.7%), with the largest age groups being 31-40 years (30.8%) and 51-60 years (28.8%). Roles included nurses (57.7%), medical assistants (25.0%), and nephrologists (15.4%). While most participants recognized the relevance of integrating palliative care into nephrology, only about half reported confidence in identifying patients with palliative care needs in their presumed last year of life. Communication about patients' preferences regarding care, treatment decisions, and advance directives occurred inconsistently, while discussions about preferred place of care or death were reported less frequently. Knowledge of legal aspects of end-of-life care and confidence in organizing referrals to palliative care services were limited. Additionally, 13 qualitative interviews were conducted with HCPs from three nephrology outpatient centers (2 nephrologists, 2 medical assistants, and 8 nurses). The interviews highlighted the complex and dynamic trajectories of patients with advanced kidney disease. Conversations about serious illness and care goals were mostly reactive, while interprofessional communication and collaboration with external providers remained limited. Training increased awareness of palliative care needs, but structural barriers such as time pressure and a treatment-focused culture hindered consistent implementation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Early integration of palliative care in outpatient nephrology is valued by HCPs, w","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute kidney injury at a tertiary nephrology referral center: predictors of renal recovery and in-hospital mortality.","authors":"Shimaa A Shabaka, Ghada El-Kannishy, Eman Nagy, Mohammed Kamal Nassar","doi":"10.1186/s12882-026-05296-z","DOIUrl":"10.1186/s12882-026-05296-z","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a global health problem associated with substantial morbidity, mortality, and healthcare costs. Despite advances in prevention and management, in-hospital mortality remains high, particularly among critically ill patients.</p><p><strong>Objectives: </strong>To determine incidence, risk factors of AKI among patients admitted to Mansoura Nephrology and Dialysis Unit (MNDU), a tertiary nephrology referral center in Dakahlia governorate, Egypt, over one year, and to identify predictors of renal recovery at discharge and in-hospital mortality.</p><p><strong>Methods: </strong>This prospective observational study was conducted from June 2022 to May 2023 and included adult patients admitted with various kidney disorders. Patients were classified into AKI and non-AKI groups according to KDIGO 2012 criteria. Clinical, laboratory, and outcome data were analyzed, and multivariable regression analyses were used to identify independent predictors of in-hospital mortality and renal recovery after AKI.</p><p><strong>Results: </strong>A total of 839 patients were enrolled, including 330 (39.3%) with AKI and 509 (60.7%) without AKI. The most common pathophysiological causes of AKI were pre-renal (54.2%) followed by intrinsic renal (38.5%) one. In-hospital mortality was significantly higher in AKI than non-AKI group (17.3% vs. 3.8%), with septic shock being the leading cause of death (84.2%). Among patients with AKI, 45.2% achieved complete renal recovery, 21.8% had partial recovery, and 33.0% had no recovery at discharge. On multivariable logistic regression analyses, KDIGO Stage 3 AKI (adjusted OR 0.277, P = 0.046), kidney replacement therapy (adjusted OR 0.409, P = 0.004), and requirement of vasopressor therapy (adjusted OR 0.041, P < 0.001) were independently associated with lower odds of renal recovery, whereas necessity of vasopressor therapy emerged as the only independent predictor of in-hospital mortality (adjusted OR 420.511, 95% CI 97.451-1814.543; P < 0.001).</p><p><strong>Conclusions: </strong>AKI was common among hospitalized patients and was associated with substantially increased in-hospital mortality. Vasopressor requirement was the strongest independent predictor of mortality, emphasizing the prognostic impact of hemodynamic instability and critical illness severity. Severe AKI (KDIGO Stage 3), kidney replacement therapy, and vasopressor necessity were independently associated with reduced renal recovery at discharge. These readily available clinical indicators may support early risk stratification and guide closer monitoring of high-risk patients.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stage-dependent alterations in MaR1 in pediatric chronic kidney disease: a potential candidate biomarker.","authors":"Muhammet Akif Guler, Muhammet Celik, Hamza Halici, Zafer Bayraktutan, Emir Enis Yurdgulu, Yusuf Anil Ay, Halil Keskin","doi":"10.1186/s12882-026-05407-w","DOIUrl":"https://doi.org/10.1186/s12882-026-05407-w","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) in children is characterized by persistent inflammation and oxidative stress, contributing to progressive loss of renal function and multisystem involvement. Maresin 1 (MaR1), a specialized pro-resolving lipid mediator derived from docosahexaenoic acid (DHA), plays a role in the resolution of inflammation and tissue repair. However, its circulating concentrations in pediatric CKD have not been examined. This study aimed to determine serum MaR1 levels across CKD stages in children and to assess its potential relevance as a biomarker reflecting disease severity.</p><p><strong>Methods: </strong>Children were categorized as healthy controls or assigned to CKD stages 1-5 according to estimated glomerular filtration rate (eGFR). In patients receiving hemodialysis, blood samples were obtained 48 h after the preceding dialysis session and immediately before the subsequent session. Serum MaR1 concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Group comparisons were performed using one-way ANOVA with Tukey's post-hoc test (p < 0.05).</p><p><strong>Results: </strong>Serum MaR1 levels differed significantly among the six groups (p < 0.001). Mean MaR1 concentrations were 110.20 ± 18.15 pg/mL in healthy controls, 20.01 ± 7.23 pg/mL in CKD stage 1, 39.61 ± 7.60 pg/mL in stage 2, 60.73 ± 12.79 pg/mL in stage 3, 203.86 ± 22.06 pg/mL in stage 4, and 284.56 ± 25.75 pg/mL in stage 5. MaR1 levels showed a marked reduction at stage 1, followed by progressive recovery and substantial elevation in advanced CKD.</p><p><strong>Conclusions: </strong>Serum MaR1 concentrations show a stage-dependent pattern in pediatric CKD, characterized by marked suppression at stage 1 followed by progressive recovery and elevation in advanced stages. These findings suggest that circulating MaR1 may represent a candidate biomarker of disease-related inflammatory dynamics; however, its clinical utility requires validation in larger longitudinal studies.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Kidney biopsy analysis of 14 cases of renal disease after unrelated cord blood transplantation.","authors":"Masato Mizuta, Naoki Sawa, Tatsuya Suwabe, Yuki Oba, Akinari Sekine, Masayuki Yamanouchi, Hiroki Mizuno, Noriko Inoue, Kiho Tanaka, Eiko Hasegawa, Atsushi Wake, Junichi Hoshino, Kei Kono, Kenichi Ohashi, Yutaka Yamaguchi, Makoto Fukuda, Motoaki Miyazono, Takehiko Wada, Yoshifumi Ubara","doi":"10.1186/s12882-026-05380-4","DOIUrl":"10.1186/s12882-026-05380-4","url":null,"abstract":"","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: A comparative study on the clinicopathological features and short-term prognosis of IgA-dominant infection-related glomerulonephritis and IgA nephropathy.","authors":"Junfeng Zhong, Dheji Yangzong, Yina Wang, Bao Dong, Meishun Cai, Chunying Shao, Xin Li, Yu Yan, Li Zuo","doi":"10.1186/s12882-026-05382-2","DOIUrl":"10.1186/s12882-026-05382-2","url":null,"abstract":"","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal care readiness and gaps in early detection of sickle cell nephropathy in children in North Kivu Province, Democratic Republic of the Congo: an exploratory cross-sectional study.","authors":"Mupenzi Mumbere, Kahindo Kangitsi Charles, Kambale Malengera Victor, Lwanzo Sindikubyo Zaccharie, Katsuva Mbahweka François, Tsongo Kibendelelwa Zaccharie","doi":"10.1186/s12882-026-05135-1","DOIUrl":"10.1186/s12882-026-05135-1","url":null,"abstract":"<p><strong>Background: </strong>Sickle cell nephropathy is a common and progressive complication of sickle cell disease in children and a major contributor to early morbidity and long-term chronic kidney disease. Although early renal screening is essential to prevent irreversible damage, its implementation remains limited in resource-constrained settings. This study assessed healthcare provider readiness for the early detection and management of sickle cell nephropathy in North Kivu Province, Democratic Republic of the Congo.</p><p><strong>Methods: </strong>We conducted an exploratory cross-sectional study among medical and paramedical healthcare providers involved in the care of children with sickle cell disease. Data were collected using a structured electronic questionnaire evaluating knowledge, attitudes, practices, and diagnostic availability related to renal screening. Composite scores were constructed for these domains, and factors associated with adequate renal care readiness were examined using multivariable logistic regression.</p><p><strong>Results: </strong>Two hundred providers were included. Adequate knowledge was observed in 50.5% of participants, while only 21.0% demonstrated favorable attitudes. Reported practices were poor, with good practice identified in only 4.1% of respondents. Diagnostic availability was limited (mean score 39.8 ± 23.5), particularly in primary and secondary facilities. Overall renal care readiness was suboptimal, and adequate diagnostic availability emerged as the main independent determinant. Key barriers included recurrent shortages of diagnostic supplies, financial constraints, and high workload, whereas standardized protocols and institutional support were reported as facilitators.</p><p><strong>Conclusions: </strong>Despite moderate knowledge levels, early renal screening for children with sickle cell disease is insufficiently implemented in North Kivu. Health system capacity, especially access to essential diagnostic tools, is central to effective renal care readiness. Strengthening diagnostic availability, standardizing care pathways, and reinforcing targeted training may substantially improve early detection and prevention of kidney disease in resource-limited settings.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose-response associations of the composite dietary antioxidant index and related nutrients with prevalent chronic kidney disease: NHANES 2003-2018.","authors":"Huian Tang, Huibing Nie, Zejun Chen, Guangyu Ao, Yi Wu, Jing Li, Yuan Chen, Min Chen","doi":"10.1186/s12882-026-05355-5","DOIUrl":"10.1186/s12882-026-05355-5","url":null,"abstract":"<p><strong>Background: </strong>Oxidative stress is implicated in kidney dysfunction, but population-based evidence linking dietary antioxidant profiles to prevalent chronic kidney disease (CKD) remains limited. We examined associations of the composite dietary antioxidant index (CDAI) and selected antioxidant-related nutrients with prevalent CKD among U.S. adults aged ≥45 years.</p><p><strong>Methods: </strong>This cross-sectional analysis used 2003-2018 National Health and Nutrition Examination Survey (NHANES) data from adults with complete exposure, outcome, and covariate data and positive fasting subsample weights. CDAI summed standardized intakes of vitamins A, C, and E, selenium, zinc, and total carotenoids from the first 24-hour recall; niacin was examined separately. CKD was operationally defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m² and/or a urinary albumin-to-creatinine ratio ≥ 30 mg/g based on a single examination. Primary analyses used WTSAF2YR/8 because Model 3 included fasting glucose. Survey-weighted logistic regression, restricted cubic splines, sequential dietary adjustment, residual-method energy adjustment, and age-expanded sensitivity analyses were performed.</p><p><strong>Results: </strong>Among 8,676 participants, 2,058 had CKD. In Model 3, the odds ratio (OR) per 1-SD increase in CDAI was 0.816 (95% confidence interval [CI], 0.751-0.887). Vitamin E, selenium, zinc, and niacin were also inversely associated with CKD, whereas vitamin A, vitamin C, and total carotenoids were not. After simultaneous adjustment for total energy, protein, sodium, potassium, and phosphorus, the CDAI association was attenuated (OR, 0.973; 95% CI, 0.841-1.127), whereas vitamin E remained inversely associated (OR, 0.869; 95% CI, 0.768-0.982). Residual-method analyses produced a similar pattern for CDAI (OR, 0.913; 95% CI, 0.831-1.004) and vitamin E (OR, 0.869; 95% CI, 0.784-0.962). In an age-expanded analysis of 14,798 adults aged ≥20 years, the CDAI association differed between adults aged 20-44 and ≥45 years (P for interaction = 0.022).</p><p><strong>Conclusions: </strong>The sensitivity of the inverse CDAI-CKD association to adjustment for energy and correlated dietary factors suggests that CDAI may partly reflect broader dietary quality, food-source patterns, and nutritional status rather than an independent antioxidant-related effect. The comparatively stable vitamin E association is hypothesis-generating and does not establish an independent protective effect.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residential altitude, aerosol optical depth, and diagnostic composition of biopsy-confirmed renal diseases: a single-center renal biopsy study from Yunnan, China.","authors":"Xinyu Wang, Jian Xu, Meiyu Chen, Qiao Wang, Yaling Li, Yaling Yu, Feifei Liu, Chunli Liu, Yutaka Kakizoe, Ying Shen, Masashi Mukoyama, Qinyuan Deng","doi":"10.1186/s12882-026-05386-y","DOIUrl":"10.1186/s12882-026-05386-y","url":null,"abstract":"<p><strong>Background: </strong>Residential altitude may influence human physiology and reflect broader environmental gradients, but its relationship with the diagnostic composition of biopsy-confirmed renal diseases remains unclear.</p><p><strong>Methods: </strong>We retrospectively studied patients undergoing native kidney biopsy at The First People's Hospital of Yunnan Province, China, between February 2023 and February 2026. Residential altitude was derived from geocoded permanent addresses and analyzed using altitude quartiles and continuous models per 500-m increase. Restricted cubic spline analyses were performed as exploratory analyses. Environmental exposures were assigned according to geocoded residential coordinates and matched to the calendar year of kidney biopsy. Logistic regression and Firth penalized logistic regression compared biopsy-confirmed ANCA-associated renal vasculitis with other biopsy-confirmed renal diagnoses, with an additional sensitivity analysis using an expanded clinical-or-pathological ANCA outcome.</p><p><strong>Results: </strong>Among 1,602 patients, 1,593 had available altitude data. The overall distribution of renal pathological diagnoses did not differ across altitude quartiles. Exploratory restricted cubic spline analyses showed no significant altitude association for most major diagnoses, whereas ANCA-associated renal vasculitis demonstrated an inverse overall association without evidence of nonlinearity. In the selected multivariable model adjusted for age, sex, BMI, and ethnicity, each 500-m increase in altitude was associated with lower odds of biopsy-confirmed ANCA-associated renal vasculitis relative to other biopsy diagnoses (OR 0.51, 95% CI 0.34-0.77; P = 0.001). Similar results were observed in Firth penalized logistic regression. The association was attenuated after additional adjustment for distance to Kunming and AOD.</p><p><strong>Conclusions: </strong>In this single-center biopsy-based cohort from Yunnan, residential altitude was not associated with broad differences in the overall spectrum of renal pathological diagnoses. Biopsy-confirmed ANCA-associated renal vasculitis accounted for a lower relative proportion of biopsy diagnoses at higher residential altitude, but this association was attenuated after accounting for geographic and environmental factors. These findings suggest that altitude-related patterns in renal biopsy diagnoses may reflect combined geographic, environmental, and referral-related gradients and should be interpreted within the context of a hospital-based biopsy population.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing evidence gaps in haemodialysis care: a critical review of clinical trials, technological innovations, and implementation priorities.","authors":"Sharon Huish, Rebecca Barnes, Sunil Bhandari, Andrew Davenport, Charles J Ferro, Mark Lambie, Sarah McMillan, Clare Morlidge, Rona Smith, David C Wheeler, Fokko P Wieringa, James O Burton","doi":"10.1186/s12882-026-05384-0","DOIUrl":"10.1186/s12882-026-05384-0","url":null,"abstract":"<p><p>Kidney failure treated with maintenance haemodialysis (HD) carries high risks of premature mortality, hospitalisation and impaired quality of life, yet important evidence gaps persist across routine HD care. The Dialysis Research Innovation Network, part of the UK Kidney Research Consortium, convened the inaugural UK Haemodialysis Research Nexus in Birmingham on 11th May 2026. There were fifty-six delegates: 22 doctors, 13 nurses, six dietitians, one renal scientist, seven people in other roles (including one patient), and seven whose role was not recorded. The meeting reviewed recent trials, emerging technologies, research methods, career development and national priorities. The NightLife trial randomised 100 participants to extended-hours in-centre nocturnal or conventional daytime HD. Recruitment was below target and consequently its primary quality-of-life result was inconclusive (adjusted mean difference 3.00 points, 95% CI -12.4 to 18.3), while exploratory secondary findings generated hypotheses concerning cognition, biochemical control and treatment burden. PISCES found fewer serious cardiovascular events with 4 g/day n-3 polyunsaturated fatty acids than placebo (0.31 versus 0.61 events per 1,000 patient-days; hazard ratio 0.57, 95% CI 0.47-0.70), without a clear all-cause mortality benefit. PHOSPHATE continues to test intensive versus liberal phosphate targets using pragmatic international infrastructure. Portable, wearable and implantable kidney-replacement technologies, patient-inclusive trial design, routinely collected data, knowledge mobilisation, mentorship and a James Lind Alliance priority-setting partnership were also discussed. The meeting identified the need for inclusive eligibility, proportionate funding, lower-burden trial delivery and outcomes that matter to patients. These proceedings are a structured report of presentations and discussion rather than a formal consensus guideline. Sustained collaboration among patients, clinicians, researchers, registries and funders is needed to convert innovation into equitable improvements in HD care.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}