BMC Nephrology最新文献

{"title":"Association of abdominal aortic calcification with cognitive impairment in peritoneal dialysis patients.","authors":"Conghui Liu, Yanan Shi, Jiajie Cai, Tingting Bai, Jingjing Li, Lingju Yue, Zhongxin Li","doi":"10.1186/s12882-025-04056-9","DOIUrl":"10.1186/s12882-025-04056-9","url":null,"abstract":"<p><strong>Background: </strong>Patients on peritoneal dialysis (PD) frequently have cognitive impairment, which is linked to a poor prognosis. The purpose of this study was to determine whether abdominal aortic calcification (AAC) may have an impact on PD patients' cognitive function.</p><p><strong>Methods: </strong>In this cross-sectional study of 110 PD patients, cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and AAC severity was quantified via lateral lumbar radiography (Kauppila method). Participants were stratified by AAC severity into high (HAAC; score ≥ 4) and low (LAAC; score < 4) groups.</p><p><strong>Results: </strong>Cognitive impairment (MoCA < 26) was present in 65.45% of patients. The HAAC group (71.8% of cohort) exhibited distinct metabolic profiles compared to LAAC: older age (63.2 ± 9.8 vs. 47.4 ± 12.1 years, P < 0.001), higher diabetes prevalence (68.4% vs. 22.6%, P < 0.001), elevated serum phosphorus (1.62 ± 0.45 vs. 1.30 ± 0.42 mmol/L, P < 0.001), and lower diastolic blood pressure (79.2 ± 10.8 vs. 86.6 ± 13.4 mmHg, P = 0.005). Notably, HAAC patients had reduced serum creatinine (898.4 ± 251.9 vs. 1190.7 ± 243.5 µmol/L, P < 0.001) and iPTH levels (142.5 vs. 218.0 pg/mL, P = 0.011), suggesting concurrent mineral bone disorder. Multivariate analysis identified AAC severity (OR = 1.28 per 1-point increase, 95%CI = 1.09-1.50) and age (OR = 1.12/year, 95%CI = 1.06-1.19) as independent predictors of cognitive impairment.</p><p><strong>Conclusion: </strong>AAC severity demonstrates a strong, dose-dependent association with cognitive dysfunction in PD patients, independent of traditional risk factors. The combination of elevated phosphorus and suppressed iPTH in high-AAC patients highlights the potential role of mineral metabolism dysregulation in both vascular calcification and neurocognitive decline.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"132"},"PeriodicalIF":2.2,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596206","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 phosphate binders on mortality and cardiovascular disease in end-stage renal disease patients with hyperphosphatemia: a multicenter real-world cohort study.","authors":"Kamolpat Chaiyakittisopon, Oraluck Pattanaprateep, Wanchana Ponthongmak, Patratorn Kunakorntham, Anan Chuasuwan, Atiporn Ingsathit, Gareth J Mckay, John Attia, Ammarin Thakkinstian","doi":"10.1186/s12882-025-04058-7","DOIUrl":"10.1186/s12882-025-04058-7","url":null,"abstract":"<p><strong>Background: </strong>Uncontrolled hyperphosphatemia in end stage renal disease (ESRD) increases the risk of cardiovascular disease (CVD), bone disorders, and premature mortality. Randomized controlled trials show reduced CVD risk of non-calcium-based phosphate-binders (NCBPBs) compared to CBPBs although evidence from real world data is less consistent. This study aimed to compare the effectiveness of NCBPBs, CBPBs, to no phosphate-binder (PB) on mortality and cardiovascular disease in Thai hyperphosphatemic ESRDs.</p><p><strong>Methods: </strong>A retrospective-cohort was conducted by using data from 2 university hospitals between January 2010 and July 2020 (COA. MURA2020/1398 and IRB No.100/63). Primary outcomes were overall survival (OS) and CVD-free time. Secondary outcomes included bone disorders following ESRD. An inverse-probability weighting with regression adjustment was used to assess treatment effects.</p><p><strong>Results: </strong>A total of 8,005 patients were included. Initial CBPBs were associated with both longer OS and CVD-free time compared to no-PBs, while initial treatment with aluminum hydroxide was the highest risk of bone disorders. Patients who received CBPBs-NCBPBs had longest OS, followed by aluminum hydroxide, and CBPBs, with average OS of 13.5, 11.0, and 10.9 years, respectively. The average CVD-free time was longest for the CBPBs-NCBPBs, followed by CBPBs-CBPBs compared to no-PBs. However, these comparisons were insignificantly different.</p><p><strong>Conclusions: </strong>initial hyperphosphatemic ESRD treatment with CBPBs provided longer OS and CVD-free time compared to no-PBs, while aluminum hydroxide was the highest risk of bone disorders. CBPBs followed by NCBPBs achieved the longest OS and CVD-free time, although these were statistical non-significance.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"131"},"PeriodicalIF":2.2,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596150","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 impact of low dietary inflammatory index diet on clinical parameters in patients with chronic kidney disease: a retrospective comparative study.","authors":"Weijuan Pan, Jian Feng","doi":"10.1186/s12882-025-04052-z","DOIUrl":"10.1186/s12882-025-04052-z","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) poses a significant global health challenge. Inflammation plays a central role in the pathogenesis and progression of CKD, which has been proved to be affected by dietary patterns. To understand how dietary inflammatory index (DII) impacts the disease course and clinical parameters, we aim to explore the relationship between DII and multiple clinical parameters in a specific cohort of CKD patients, and to provide insights into the potential of dietary for managing CKD.</p><p><strong>Methods: </strong>This retrospective comparative study included 145 CKD patients, categorized into a low DII group (n = 77) and a high DII group (n = 68) based on their DII values. Clinical data, including demographic characteristics, laboratory parameters, dietary intake, inflammatory markers, renal function, and adverse events, were collected and compared between the two groups.</p><p><strong>Results: </strong>The demographic characteristics were comparable between the groups. The low DII group had significantly lower serum creatinine, phosphorus, and potassium levels (P < 0.05) and higher hemoglobin levels compared to the high DII group. Protein intake was significantly higher in the high DII group (P < 0.001), while fiber intake was significantly higher in the low DII group (P = 0.022). Inflammatory markers, including CRP, TNF-α, fibrinogen, procalcitonin, and WBC, were significantly lower in the low DII group (P < 0.05). The low DII group also showed better renal function, as indicated by higher GFR and lower urinary albumin excretion (P < 0.05). Correlation analysis revealed significant relationships between protein intake and inflammation markers (CRP, TNF-α, fibrinogen) and a negative correlation with GFR. Regression analysis confirmed that DII was independently associated with CRP, GFR, and urinary albumin excretion, while protein intake remained significantly correlated with these outcomes.</p><p><strong>Conclusion: </strong>A low DII diet may be associated with improved clinical parameters, inflammatory markers, and renal function in CKD patients. Tailored nutritional strategies focusing on modulating inflammatory status through low DII diets may offer promising avenues for improving renal function, mitigating inflammation, and enhancing overall well-being in individuals with CKD.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"129"},"PeriodicalIF":2.2,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596157","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":"Optimization of screening strategy for chronic kidney disease by urine test strips using the albumin-creatinine read-out.","authors":"Stijn Lambrecht, Marijn Speeckaert, Matthijs Oyaert","doi":"10.1186/s12882-025-04048-9","DOIUrl":"10.1186/s12882-025-04048-9","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical laboratories play an important role in the diagnosis and monitoring of chronic kidney disease (CKD). Our aim was to evaluate the performance of qualitative and semi-quantitative albumin-to-creatinine ratio (ACR) and protein-to-creatinine ratio (PCR) test strip results as screening tools for albuminuria in multiple representative patient cohorts.</p><p><strong>Materials and methods: </strong>ACR and PCR were evaluated in both cross-sectional (n = 940) and validation (n = 927) patient cohorts. Semi-quantitative urinary ACR and PCR were performed using a UC-3500 instrument (Sysmex, Kobe, Japan). The diagnostic performance of semi-quantitative ACR and PCR was determined using quantitative ACR and PCR as reference method.</p><p><strong>Results: </strong>In the cross-sectional cohort, a sensitivity and specificity of 78.1% and 93.3%, respectively, were obtained for semi-quantitative ACR at a cut-off of 30 mg/g creatinine, with an overall agreement of > 90% between both methods. The sensitivity and specificity increased in the target population (validation cohort) to 89.9% and 92.1%, respectively. In contrast, the sensitivities of qualitative protein concentration (78.6%) and semi-quantitative PCR (69.8%) were lower.</p><p><strong>Conclusion: </strong>The results confirm that urine test strip readouts are a valuable screening tool for CKD in low-risk individuals. ACR should be the preferred criterion for reflex testing when using a urine test strip for screening CKD.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"130"},"PeriodicalIF":2.2,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596154","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":"Effect of N-acetylcysteine on antimicrobials induced nephrotoxicity: a meta-analysis.","authors":"Xianming Qiu, Shenao Yang, Yuke Zhang, Quanzhen Wang, Li Kong, Lei Zhou","doi":"10.1186/s12882-025-04037-y","DOIUrl":"10.1186/s12882-025-04037-y","url":null,"abstract":"<p><strong>Objective: </strong>N-acetylcysteine (NAC) has antioxidant effects in reducing acute kidney injury. This study systematically reviewed and assessed the efficacy of NAC in preventing antimicrobials induced nephrotoxicity.</p><p><strong>Methods: </strong>Pubmed, Embase, Web of Science, and the Cochrane Library were searched extensively for relevant studies that evaluating NAC on antimicrobials induced nephrotoxicity until June 1, 2024. Eligible records were screened according to the inclusion and exclusion criteria. The odds ratio (OR) was selected to evaluate the effect of NAC on nephrotoxicity. We pooled the extracted data using a random effects model.</p><p><strong>Results: </strong>Three randomized controlled trials were included in the analysis. The pooled results showed that NAC could reduce the incidence of antimicrobials induced nephrotoxicity (OR = 0.487, 95% CI = 0.258, 0.918, P = 0.03, I² = 0%). Serum creatine (Scr) on Day 2 was significantly decreased in the NAC group compared to the placebo group (SMD, - 0.298; 95%CI, - 0.585 to - 0.010; I² = 23%; P = 0.04). No difference was observed in blood urea nitrogen (BUN), and creatinine clearance (CrCl).</p><p><strong>Conclusion: </strong>In this meta-analysis, NAC was associated with a benefit in the prevention of antimicrobials induced nephrotoxicity. However, large-scaled and well-designed RCTs are required in the future.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"128"},"PeriodicalIF":2.2,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584687","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":"Ketogenic diets and β-hydroxybutyrate in the prevention and treatment of diabetic kidney disease: current progress and future perspectives.","authors":"Junle Li, Wanhong He, Qianshi Wu, Yuanyuan Qin, Changfang Luo, Zhuojun Dai, Yang Long, Pijun Yan, Wei Huang, Ling Cao","doi":"10.1186/s12882-025-04019-0","DOIUrl":"10.1186/s12882-025-04019-0","url":null,"abstract":"<p><p>Diabetic kidney disease (DKD) is the main cause of end-stage renal disease. Ketogenic diets (KD) is a high-fat, low-carbohydrate diet. KD produces ketone bodies to supplement energy in the case of insufficient glucose in the body. β-Hydroxybutyrate (BHB) is the main component of ketone bodies. BHB serves as \"ancillary fuel\" substituting (but also inducing) anti-oxidative, anti-inflammatory, and cardio-protective features by binding to several target proteins, including histone acylation modification, or G protein-coupled receptors (GPCRs). KD have been used to treat epilepsy, obesity, type-2 diabetes mellitus, polycystic ovary syndrome, cancers, and other diseases. According to recent research, KD and the induced BHB delay DKD progression by improving the metabolism of glucose and lipids, regulating autophagy, as well as alleviating inflammation, oxidative stress and fibrosis. However, due to some side-effects, the role and mechanism of action of KD and BHB in the prevention and treatment of DKD are controversial. This review focuses on recent progress in the research of KD and BHB in clinical and preclinical studies of DKD, and provides new perspectives for DKD treatment.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"127"},"PeriodicalIF":2.2,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584694","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":"Polycythemia secondary to bilaterally enlarged kidneys in T-Cell acute lymphoblastic leukemia: a case report and literature review.","authors":"Koji Yoshimoto, Yujiro Maeoka, Shiori Kubota, Ren Chishaki, Akira Takahashi, Yosuke Osaki, Tatsuji Mino, Tatsuo Ichinohe, Takao Masaki","doi":"10.1186/s12882-025-04032-3","DOIUrl":"10.1186/s12882-025-04032-3","url":null,"abstract":"<p><strong>Background: </strong>Polycythemia is a rare disease that can cause hypertension. Secondary polycythemia with increased production of erythropoietin (EPO) is associated with several kidney diseases, including hydronephrosis and cystic disease. However, there have been no reports of a case presenting with polycythemia secondary to bilateral nephromegaly caused by renal infiltration of T-cell acute lymphoblastic leukemia (T-ALL).</p><p><strong>Case presentation: </strong>A 32-year-old Japanese man presented with marked hypertension (215/150 mmHg) with renal insufficiency (creatinine 3.7 mg/dL), proteinuria, hematuria, bilateral nephromegaly, polycythemia (hemoglobin 20.2 g/dL), and increased serum EPO (38.7 mIU/mL, range 4.2-23.7 mIU/mL). Based on renal and bone marrow biopsy findings, he was diagnosed with T-ALL and bilaterally enlarged kidneys caused by renal infiltration of leukemic cells. There was no evidence of endocrine hypertension or fluid retention. Remission induction chemotherapy led to a decrease in kidney size, hemoglobin levels, and serum EPO levels, and allowed dose reductions of most hypertensive drugs, suggesting that hypertension was secondary to polycythemia. The patient's renal function gradually improved and hemodialysis was discontinued after 1 month of chemotherapy.</p><p><strong>Conclusions: </strong>We report a case of marked hypertension and secondary polycythemia induced by severe renal infiltration of T-ALL at diagnosis, which were synchronically improved with induction chemotherapy. This case history suggests the importance of considering lymphoproliferative diseases in the differential diagnosis of secondary polycythemia, leading to severe hypertension.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"121"},"PeriodicalIF":2.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565894","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":"Study on HIF-PHI combined with iron supplement in treatment of renal anemia in rats.","authors":"Zhaoli Gao, Yanxia Gao, Qiang Wang, Qi Wang, Peng Lu, Hailin Lv, Haoran Xue, Xiaotian Ma, Shuen Li, Zhao Hu","doi":"10.1186/s12882-025-04045-y","DOIUrl":"10.1186/s12882-025-04045-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Roxadustat is a novel hypoxia- inducible factor-prolyl hydroxylase inhibitor(HIF-PHI) used to treat anemia in chronic kidney disease (CKD) patients. It has been reported that roxadustat can slow down kidney damage and delay the development of kidney fibrosis. Anemia and iron deficiency are often associated with the vast majority CKD patients, and insufficient available iron or total iron storage is often the most common cause of anemia and ESAs resistance in CKD patients. The role of iron availability in the pathogenesis of anemia in chronic kidney disease has received increasing attention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To explore whether combined roxadustat and polysaccharide-iron complex (PIC) is more successful than standalone roxadustat, the appropriate iron supplement dosage and mechanism of roxadustat in the treatment of CKD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Healthy male Sprague Dawley rats were randomly divided into two groups: the control (NC) group which were sham-operated and the CKD group. The CKD group was given an adenine diet for three weeks after right unilateral nephrectomy and further divided into 6 groups: the CKD only, CKD + PIC, CKD + Roxa, CKD + PIC (25 mg/kg) + Roxa, CKD + PIC (50 mg/kg) + Roxa, and CKD + PIC (75 mg/kg) + Roxa groups. The sham-operated rats receiving only standard diet served as the control group. Roxadustat were administrated intragastrically at 10 mg/kg thrice per week in groups with Roxa. The hemoglobin (Hb), reticulocyte hemoglobin equivalent (RET-He), reticulocyte % (RET%), plasma urea nitrogen (BUN), plasma creatinine (Cr), serum iron (SI), Total iron binding capacity (TIBC), serum hepcidin-25, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-1β (IL- 1β), and High mobility group protein B1 (HMGB1) levels of each group of rats were assessed. Masson staining was used to evaluate renal fibrosis, and quantitative real-time Polymerase Chain Reaction (RT-PCR) was used to detect the mRNA expression of alpha-smooth muscle actin (α-SMA) and Fibronectin (Fn) in rat renal tissues to further evaluate renal fibrosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Level of Hb in the CKD + PIC (75 mg/kg) + Roxa group increased the fastest, roxadustat combined with PIC in the treatment of renal anemia was significantly more effective than Roxadustat or PIC alone. On day 105, in the CKD + PIC (75 mg/kg) + Roxa group, there was a significant decrease in BUN and Cr levels compared to the CKD only group (p &lt; 0.05). Roxadustat reduces the level of hepcidin, IL-6, TNF-α, IL-1β and HMGB1in CKD rats. (p &lt; 0.05). Roxadustat alleviates renal fibrosis in CKD rats (p &lt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;HIF-PHI combined with iron supplement (Roxadustat combined with PIC) has an improved effect on the treatment of renal anemia, and early administration of sufficient iron enables the Hb to rise rapidly. Early administration of adequate dose of PIC is necessary for renal a","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"125"},"PeriodicalIF":2.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571618","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":"Long-term efficacy of Rituximab in steroid dependent and frequent relapsing adult nephrotic syndrome.","authors":"Omri Feder, Dana Amsterdam, Mohamad Ershed, Ayelet Grupper, Doron Schwartz, Orit Kliuk-Ben Bassat","doi":"10.1186/s12882-025-04035-0","DOIUrl":"10.1186/s12882-025-04035-0","url":null,"abstract":"<p><strong>Background: </strong>Corticosteroids are highly efficient for treatment of minimal change disease (MCD), however a substantial number of patients become steroid dependent (SD) or frequent relapsing (FR). Response rate is lower in primary Focal Segmental Glomerulosclerosis (FSGS). Since prolonged exposure to corticosteroids should be avoided, an effective alternative is required. Rituximab is a promising agent. We aimed to evaluate the efficacy of Rituximab in adults with SD/FR nephrotic syndrome (NS).</p><p><strong>Methods: </strong>A retrospective cohort study, evaluating patients with SD/FR NS treated with Rituximab in a tertiary hospital. Rituximab was given at induction, with additional doses subjected to the treating nephrologist decision. Primary outcome was number of relapses and time to first relapse. Safety was assessed.</p><p><strong>Results: </strong>Twenty-one adults were included. Among them, 14 (66.7%) were diagnosed with MCD, 5 (23.8%) with FSGS, in 2 cases kidney biopsies were not performed. Median age was 54.6 years. Median follow up was 39.6 months. Number of relapses decreased significantly after Rituximab compared to before treatment (median relapses 0 compared to 3, respectively, W = 3.70, p <.001). Time to first relapse was significantly shorter before Rituximab compared to after (median 11 vs. 536 days, respectively, W = 3.05, p =.002). Hazzard Ratio for relapse was higher in patients who received one Rituximab course compared to those who received an additional maintenance (HR = 4.31, 95% CI: 1.13-16.39, p =.032). Treatment was well-tolerated, serious adverse events included cholecystitis and severe COVID-19.</p><p><strong>Conclusions: </strong>Rituximab emerges as an efficient safe steroid sparing in patients with SD/FR NS, with longer remission achieved when an additional maintenance dose is given after the first course.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"126"},"PeriodicalIF":2.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571698","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":"Differences in training and practice in tunnelled haemodialysis catheter removal: a survey of nephrology trainees across United Kingdom.","authors":"Ismet Boral, Shalabh Srivastava, Joanna McKinnell","doi":"10.1186/s12882-025-04034-1","DOIUrl":"10.1186/s12882-025-04034-1","url":null,"abstract":"<p><strong>Background: </strong>The tunnelled haemodialysis catheter (TDC) removal is a necessary skill for the nephrology trainee as this task is undertaken routinely in renal units. Little published data exists to establish current practice and there is no national guidance regarding TDC removal in United Kingdom (UK). Anecdotally, trainees suggest they do not have sufficient supervised training in TDC removal. We aimed to establish the differences in training and practice in TDC removal among nephrology trainees across UK.</p><p><strong>Method: </strong>We created an online survey with twenty questions for trainee and non-training nephrology registrars working in UK. The survey was distributed via regional renal training programme directors, UK Kidney Association, \"Renal SpR Club\" and online professional social networks including social media and instant messaging services.</p><p><strong>Results: </strong>We received 75 responses from all of 14 postgraduate training deaneries. 91% reported renal registrars remove TDCs in their units. 53% of the operators were taught by another registrar. Only 16% report awareness of written local trust guidance on TDC removal. 43% reported removing > 10 TDCs a year. Cut-down method is preferred over traction method for TDC removal. 63% remove TDCs in designated procedure areas, 52% obtain written consent and 65% wear full sterile personal protective equipment (PPE). 16% report removing TDCs alone with no assistant and 12% do not stop aspirin, antiplatelets or anticoagulants beforehand. 30% of operators reported experiencing a \"stuck catheter\" at some point in their careers.</p><p><strong>Conclusions: </strong>This survey highlights that TDC removal is a common procedure and predominantly performed by renal physicians in teaching hospitals. It is mostly undertaken by registrar level doctors often without formal training or written guidelines with varying techniques. 68% of participants want this procedure to be part of mandatory training in the renal post graduate training curriculum.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"124"},"PeriodicalIF":2.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572079","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}