BMC Nephrology最新文献

{"title":"Prevalence and risk factors of diabetic kidney disease in Malagasy patients with diabetes mellitus: a cross-sectional study at a University Hospital Center in Antananarivo, Madagascar.","authors":"Sitraka Angelo Raharinavalona, Miarantsoa Abel Randriamanana, Solohery Jean Noel Ratsimbazafy, Fanantenana Robline Raharisoa, Andrianirina Dave Patrick Rakotomalala","doi":"10.1186/s12882-025-04435-2","DOIUrl":"10.1186/s12882-025-04435-2","url":null,"abstract":"","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"522"},"PeriodicalIF":2.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173271","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":"The Aging Kidney and Exercise Training Study: protocol for a randomized controlled trial within cohorts (TwiCs) study.","authors":"Keisei Kosaki, Shoya Mori, Hayate Namatame, Riri Kobayashi, Shun Yoshikoshi, Takashi Tarumi, Toshiaki Usui, Chie Saito, Masahiko Gosho, Yoshio Nakata, Seiji Maeda, Makoto Kuro-O, Kunihiro Yamagata","doi":"10.1186/s12882-025-04471-y","DOIUrl":"10.1186/s12882-025-04471-y","url":null,"abstract":"","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"533"},"PeriodicalIF":2.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173309","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":"Posttransplant diabetes mellitus and long-term outcomes after kidney transplantation in a steroid avoidance regimen: a cohort study.","authors":"Claire Gardiner, David Keane, Eva Ho, Virginie Lenfant, Ozlem Tankisi, Michelle Hiu Ching Yam, Sunil Daga","doi":"10.1186/s12882-025-04419-2","DOIUrl":"10.1186/s12882-025-04419-2","url":null,"abstract":"","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"520"},"PeriodicalIF":2.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173276","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 use of renin-angiotensin-aldosterone system inhibitors and stable renal function in familial focal segmental glomerulosclerosis with ACTN4 mutation: a case report and literature review.","authors":"Kisho Miyasako, Yujiro Maeoka, Yuho Adachi, Ryo Tamura, Naoki Ishiuchi, China Nagano, Kandai Nozu, Takao Masaki","doi":"10.1186/s12882-025-04441-4","DOIUrl":"10.1186/s12882-025-04441-4","url":null,"abstract":"<p><strong>Background: </strong>Genetic mutations in alpha-actinin 4 (ACTN4) are one cause of familial focal segmental glomerulosclerosis (FSGS) and steroid-resistant nephrotic syndrome (SRNS) in early adulthood, eventually progressing to end-stage kidney disease. Early initiation of renin-angiotensin-aldosterone system inhibitors (RAASis) is reported to delay progression of several forms of familial FSGS and SRNS; however, no cases involving ACTN4 mutations have been reported.</p><p><strong>Case presentation: </strong>A 16-year-old boy was admitted to our hospital for a detailed evaluation of proteinuria that first appeared during treatment for Duchenne muscular dystrophy (DMD) and persisted for 1 year. He had been treated with prednisolone and an angiotensin-converting enzyme inhibitor (ACEi) for 2 years prior to the onset of persistent proteinuria. A renal biopsy revealed segmental sclerosis in 1 of 40 glomeruli, with effaced foot processes observed under electron microscopy. Genetic testing identified ACTN4 mutation (c·776C > T, p.T259I), leading to a diagnosis of autosomal dominant FSGS caused by ACTN4 mutation. After the first appearance of proteinuria, the patient's renal function and urinary protein levels remained stable for following 7 years.</p><p><strong>Conclusions: </strong>We report a case of adolescent-onset FSGS with ACTN4 mutation diagnosed during ACEi therapy for the prevention of DMD-associated cardiomyopathy. The patient exhibited stable renal function and no disease progression compared with his father and previously reported cases with the same variant. This is the first reported case of early RAASi induction for treating ACTN4-associated FSGS with long-term stable renal function.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"521"},"PeriodicalIF":2.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173617","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":"Thrombotic microangiopathy multidisciplinary assessment team: demographics, final diagnosis, treatment, and outcomes.","authors":"Matthew Nguyen, Gayathri Dileep, Samir Patel, Fawaz Al Ammary, Minh-Ha Tran, Benjamin J Lee, Stefan Ciurea, Sheetal Desai, Alpesh Amin, Hongyu Zhao, Omid Vadpey, Dao Le, Tai Truong, Antoinette Abdelmalek, Jordan Perkins, Rebecca Ahdoot, Fatima Malik, Antoney Ferrey, Uttam Reddy, Ekamol Tantisattamo, Yongen Chang, Wei Ling Lau, Yulian Khagi, Lisa Lee, Zahra Pakbaz, Ramy M Hanna","doi":"10.1186/s12882-025-04446-z","DOIUrl":"10.1186/s12882-025-04446-z","url":null,"abstract":"","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"537"},"PeriodicalIF":2.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173299","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":"Real-world evaluation of cinacalcet on hard outcomes in hemodialysis patients in Saudi Arabia.","authors":"Riad Mohammed Abdelrahman, Azmi Mohamed Ali Abdallah, Ayaz Ahmed Ahmed, Taha Hussien Musa, Ismail Adam Arbab, Eltieb Omer Abuelgasim, Mohammed Jalal, Kannan O Ahmed, Yousif Amin Hassan, Zainab Altrefe, Huda Babikir Ahmed","doi":"10.1186/s12882-025-04455-y","DOIUrl":"10.1186/s12882-025-04455-y","url":null,"abstract":"","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"528"},"PeriodicalIF":2.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173340","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":"Serum chloride concentrations and outcomes in adult patients with cirrhosis: a systematic review and meta-analysis.","authors":"Mehdi Kashani, Lifang Wei, Waryaam Singh, Supawadee Suppadungsuk, Larry J Prokop, Kianoush B Kashani, Juan Pablo Domecq Garces","doi":"10.1186/s12882-025-04466-9","DOIUrl":"10.1186/s12882-025-04466-9","url":null,"abstract":"<p><strong>Purpose: </strong>Electrolyte disturbances, including hyponatremia, are common in cirrhosis, with hyponatremia already incorporated into the MELD-Na score as a prognostic marker. However, the prognostic role of serum chloride, the main extracellular anion, remains underexplored. Emerging evidence suggests hypochloremia is independently associated with increased mortality and acute kidney injury (AKI) in cirrhotic patients. Proposed mechanisms include dysregulated activation of the renin-angiotensin, vasopressin, and sympathetic nervous systems, leading to renal vasoconstriction and impaired function. This systematic review evaluates the association between serum chloride levels and outcomes, including mortality and KDIGO-defined AKI rates, aiming to enhance understanding and inform management strategies.</p><p><strong>Methods: </strong>This review followed PRISMA guidelines and a PROSPERO-registered protocol (CRD42024550945). Comprehensive searches of MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science were conducted through June 6, 2024, without language restrictions. Controlled vocabulary and keywords were used to identify relevant studies. Two independent reviewers performed title, abstract, and full-text screening, with disagreements resolved through consensus or third-party arbitration. Inter-rater reliability was assessed using Cohen's kappa. Data extraction and risk of bias evaluations were performed using the PROBAST tool. Findings were summarized using a PRISMA flowchart.</p><p><strong>Results: </strong>Five studies (n = 3,150) were included, primarily retrospective cohorts, with one prospective study. Hypochloremia was defined as serum chloride < 99 mEq/L in most studies, except one, which used < 107.35 mmol/L. Cirrhosis etiologies included alcohol-related liver disease (40-64%), hepatitis B (7.9-59.9%), hepatitis C (7-8.9%), and non-alcoholic fatty liver disease (7-11.7%), with fewer cases of autoimmune and cryptogenic causes. Comorbidities included diabetes mellitus (21.3%), hypertension (13.4%), and varices (72-87%), with 62-99% having a history of decompensation. Extrahepatic organ failures were prevalent, affecting 79.4% of patients, with 31.6% and 13.4% experiencing two and three organ failures, respectively.Meta-analysis showed hypochloremia was significantly associated with increased mortality (pooled OR: 2.52; 95% CI: 1.88-3.39, p < 0.0001). Individual ORs ranged from 2.08 to 17.42, with low to moderate heterogeneity (I² = 36%). Hypochloremia also correlated with elevated creatinine levels and increased AKI prevalence.</p><p><strong>Conclusion: </strong>Hypochloremia is a strong predictor of mortality and renal dysfunction in cirrhotic patients. Early recognition and management of hypochloremia are critical to improving outcomes in this high-risk population.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"536"},"PeriodicalIF":2.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173351","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":"A qualitative study of nephrologists' perspectives on implementing a nephrology rapid response model for acute kidney injury.","authors":"Bilal Jawabreh, Salam Khatib, Motasem Hamdan","doi":"10.1186/s12882-025-04449-w","DOIUrl":"10.1186/s12882-025-04449-w","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) poses major health and economic burdens, especially in low-resource settings like Palestine. This study explores nephrologists' perspectives on implementing the Nephrology Rapid Response Team (NRRT) model, highlighting key barriers, facilitators, and strategic priorities to improve AKI care.</p><p><strong>Study design: </strong>A qualitative, exploratory study design was employed to gain in-depth nephrologists' perspectives on the feasibility of implementing the Nephrology Rapid Response Team (NRRT) model in Palestinian hospitals.</p><p><strong>Methods: </strong>Thirteen board-certified nephrologists were recruited using purposive sampling. Semi-structured interviews were conducted between January and May 2024, with data transcribed verbatim and analyzed thematically using MAXQDA Analytics Pro software. Thematic analysis identified key facilitators, barriers, and recommendations. Rigorous methodological strategies ensured the credibility, dependability, and transferability of the findings.</p><p><strong>Results: </strong>Five enablers themes emerged that could facilitate integration of the model: strategic backing from the Ministry of Health, a growing orientation toward prevention-driven healthcare policies, enhanced multidisciplinary collaboration with early nephrologist engagement, institutional endorsement through hospital-based systems, and the progressive adoption of technological innovations such as electronic alert systems and novel biomarkers. On the other hand, five dominant barrier themes emerged. These include systemic governance and policy fragmentation, financial and operational limitations, a pronounced shortage of nephrology specialists, insufficient awareness and prevention frameworks, and weak collaboration and surveillance systems-particularly the lack of a national renal registry. Despite these obstacles, nephrologists expressed optimism, offering three central recommendations to support sustainable implementation. These include systemic policy and governance reforms, investments in nephrology education and training programs, and the expansion of public awareness and prevention strategies through primary care engagement. Together, these strategies represent a foundational roadmap for overcoming structural challenges and AKI care delivery through the NRRT model.</p><p><strong>Conclusions: </strong>This study highlights the Ministry of Health's critical role in leading reforms for NRRT implementation, emphasizing prevention, technology, and capacity-building as priorities to improve nephrology care.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"534"},"PeriodicalIF":2.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173512","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":"Effects of sodium zirconium cyclosilicate on the quality of life of patients with hyperkalemia undergoing hemodialysis: Y-QOL study design.","authors":"Shiori Yoshimura, Daisuke Kanai, Hiromichi Wakui, Rika Furuta, Shunichi Fukuhara, Sayaka Shimizu, Kouji Yamamoto, Yusuke Saigusa, Masaaki Hanaoka, Hiroshi Mitsuhashi, Tomoyuki Kawano, Mari Katsumata, Satoshi Yamaguchi, Nariaki Ogawa, Masato Ohsawa, Kohji Ohki, Masahiro Nishihara, Sho Kinguchi, Kengo Azushima, Tomohiko Kanaoka, Yusuke Kobayashi, Yoshiyuki Toya, Takeo Ishii, Ashio Yoshimura, Gen Yasuda, Tadashi Kuji, Toshimasa Ohnishi, Kouichi Tamura","doi":"10.1186/s12882-025-04429-0","DOIUrl":"10.1186/s12882-025-04429-0","url":null,"abstract":"<p><p>Patients undergoing hemodialysis (HD) face severe dietary potassium restrictions, reducing their quality of life (QOL) and potentially worsening their prognosis. Sodium zirconium cyclosilicate (SZC) is a novel selective potassium binder that lowers potassium levels, with minimal effects on other electrolytes. The Y-QOL study will evaluate whether SZC can improve QOL by easing the burden of dietary restrictions. This 8-week, multicenter, randomized, parallel-group, open-label trial will enroll 200 outpatients with hyperkalemia (potassium level 5.5-6.4 mEq/L after a 2-day inter-dialytic interval) on thrice-weekly HD. Participants will be randomized to receive SZC (starting dose 5 g on non-dialysis days, adjustable to 15 g based on serum potassium levels) plus dietary guidance, or dietary guidance alone to maintain serum potassium levels at 4.0-5.4 mEq/L. The primary endpoint is changes in The 7-item QOL Disease-specific Impact Scale (QDIS-7) scores at week 8 from baseline. Secondary endpoints include additional QOL scores, nutritional status, inflammation markers, Bristol Stool Form Scale, serum potassium reduction, and safety. Recruitment began on January 24, 2024, and the study will conclude on March 31, 2026. The Y-QOL study aims to determine the effectiveness of SZC in improving QOL by reducing serum potassium levels in patients with hyperkalemia undergoing HD.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"531"},"PeriodicalIF":2.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173598","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":"Effectiveness of telehealth interventions for palliative care in patients with kidney failure: a systematic review.","authors":"Manudi Vidanapathirana, Malmee Dharmawardhane, Ruwanthi Ananda, Deshan Gomez, Pasyodun Koralage Buddhika Mahesh","doi":"10.1186/s12882-025-04463-y","DOIUrl":"10.1186/s12882-025-04463-y","url":null,"abstract":"<p><strong>Background: </strong>Kidney failure affects a substantial proportion of the global population, and is associated with high morbidity and mortality. These patients require high-quality palliative care to manage symptoms and enhance quality of life. With advances in technology, telehealth offers potentially convenient and scalable means to provide this integral aspect of care. This systematic review assessed the effectiveness of telehealth interventions for providing palliative care in patients with kidney failure.</p><p><strong>Methods: </strong>A comprehensive search of PubMed (32), Cochrane (1), Google Scholar (938) and HINARI (25) yielded 1039 articles. Following the removal of duplicates, 1013 articles remained. Screening questions were developed in relation to the use of telehealth-based interventions among patients with kidney failure for palliative care. Studies on patients with stages 1-4 of chronic kidney disease, telehealth interventions related to improving renal replacement therapy, interventions focused on optimization of medical complications or drug adherence and caregiver-directed interventions were excluded. Articles were screened by two independent reviewers, with conflicts settled by a third. Risk of bias was assessed using the RoB2 tool for randomized controlled trials (RCTs). Meta-analysis was not performed following heterogeneity assessments. Registration was done in PROSPERO registry with the ID CRD42024582255.</p><p><strong>Results: </strong>Four RCTs were included in the final review. Two had low risk of bias while the other two had moderate risk. Three of the interventions were nurse-led telehealth interventions that focused on post-discharge follow up with outcomes related to quality of life and symptom control. The other focused on cognitive behavioral therapy (CBT) delivered via telehealth. All post-discharge follow-up telehealth interventions showed significant improvements in symptom control and quality of life. The CBT intervention also demonstrated significant improvement in symptom control.</p><p><strong>Conclusions: </strong>Telehealth interventions for provision of palliative care in patients with kidney failure seem promising for improvement of symptom control and quality of life.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"529"},"PeriodicalIF":2.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173649","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}