BMC Nephrology最新文献

{"title":"Potassium binders in clinical practice: understanding potassium binder use in contemporary Swedish healthcare-the DEMONSTRATE database.","authors":"Hans Furuland, Anders Olof Larsson, Per Bjellerup, Milica Uhde, Thomas Cars, Matilda Almstedt, Maria K Svensson","doi":"10.1186/s12882-025-04146-8","DOIUrl":"https://doi.org/10.1186/s12882-025-04146-8","url":null,"abstract":"<p><strong>Background: </strong>Potassium binders mitigate hyperkalemia, allowing patients to maintain their renin-angiotensin-aldosterone-system inhibitor (RAASi) treatment. This study characterized patients treated with first- or second-generation potassium binders, usage patterns and their effectiveness in reducing potassium levels, and changes in RAASi treatment in a Swedish population-based study.</p><p><strong>Methods: </strong>A National Cohort included patients who had record of a treatment episode with a first-generation or second-generation potassium binder between 2018 and 2022. A Mid-Sweden Cohort included patients from the National Cohort who also had a record of a potassium measurement within the 60 days prior to beginning potassium binder treatment. Comorbidities, prior medication use, persistence with potassium binder treatment, subsequent changes in potassium levels and RAASi treatment were evaluated. Persistence was analyzed using the Kaplan-Meier estimator and changes in potassium levels were assessed using linear mixed-effects models.</p><p><strong>Results: </strong>23,892 treatment episodes involving 14,235 patients (mean age 70 years, 33% women) were followed in the National Cohort, and 4860 episodes involving 3179 patients (mean age 72 years, 34% women) in the Mid-Sweden Cohort. Patients treated with second-generation potassium binders had more comorbidities and higher median persistence with treatment compared to those on first-generation potassium binders, 112.5 (95% CI:112.5-117.5) vs. 87.5 (95% CI: 87.5-87.5) days in the National Cohort; 165.5 (95% CI: 121.0-198.0) vs. 97.6 (95% CI: 87.5-110.0) days in the Mid-Sweden Cohort. Both first- and second-generation potassium binders reduced potassium levels from baseline by day 15, 5.7 [95% CI: 4.5-6.8] mmol/L to 4.7 [95% CI: 3.6-5.9] mmol/L and 5.5 (95% CI: 4.3-6.7) mmol/L to 4.9 (95% CI: 3.8-6.1) mmol/L, respectively. Dose reduction or discontinuation of renin-angiotensin system inhibitors (RASi) or mineralocorticoid receptor antagonists (MRAs) was found in 31.4% and 47.7%, respectively, within 120 days of initiating therapy.</p><p><strong>Conclusion: </strong>Both potassium binders effectively reduced potassium levels, but frequent discontinuation or dose reduction of RAASi therapy were still observed during this period. The adjustments of RAASi therapy, despite the achievement of normokalemia within 15 days, may be premature and warrants careful reconsideration to ensure optimal patient outcomes.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"213"},"PeriodicalIF":2.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963560","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":"Intermittent hypoxemia during hemodialysis: AI-based identification of arterial oxygen saturation saw-tooth pattern.","authors":"Hanjie Zhang, Andrea Nandorine Ban, Peter Kotanko","doi":"10.1186/s12882-025-04133-z","DOIUrl":"https://doi.org/10.1186/s12882-025-04133-z","url":null,"abstract":"<p><strong>Background: </strong>Maintenance hemodialysis patients experience high morbidity and mortality, primarily from cardiovascular and infectious diseases. It was discovered recently that low arterial oxygen saturation (SaO₂) is associated with a pro-inflammatory phenotype and poor patient outcomes. Sleep apnea is highly prevalent in maintenance hemodialysis patients and may contribute to intradialytic hypoxemia. In sleep apnea, normal respiration patterns are disrupted by episodes of apnea because of either disturbed respiratory control (i.e., central sleep apnea) or upper airway obstruction (i.e., obstructive sleep apnea). Intermittent SaO₂ saw-tooth patterns are a hallmark of sleep apnea. Continuous intradialytic measurements of SaO₂ provide an opportunity to follow the temporal evolution of SaO₂ during hemodialysis. Using artificial intelligence, we aimed to automatically identify patients with repetitive episodes of intermittent SaO₂ saw-tooth patterns.</p><p><strong>Methods: </strong>The analysis utilized intradialytic SaO₂ measurements by the Crit-Line device (Fresenius Medical Care, Waltham, MA). In patients with an arterio-venous fistula as vascular access, this FDA approved device records 150 SaO₂ measurements per second in the extracorporeal blood circuit of the hemodialysis system. The average SaO₂ of a 10-second segment is computed and streamed to the cloud. Periods comprising thirty 10-second segments (i.e., 300 s or five minutes) were independently adjudicated by two researchers for the presence or absence of SaO₂ saw-tooth pattern. We built one-dimensional convolutional neural networks (1D-CNN), a state-of-the-art deep learning method, for SaO₂ pattern classification and randomly assigned SaO₂ time series segments to either a training (80%) or a test (20%) set.</p><p><strong>Results: </strong>We analyzed 4,075 consecutive 5-minute segments from 89 hemodialysis treatments in 22 hemodialysis patients. While 891 (21.9%) segments showed saw-tooth pattern, 3,184 (78.1%) did not. In the test data set, the rate of correct SaO₂ pattern classification was 96% with an area under the receiver operating curve of 0.995 (95% CI: 0.993 to 0.998).</p><p><strong>Conclusion: </strong>Our 1D-CNN algorithm accurately classifies SaO₂ saw-tooth pattern. The SaO₂ pattern classification can be performed in real time during an ongoing hemodialysis treatment, provide timely alert in the event of respiratory instability or sleep apnea, and trigger further diagnostic and therapeutic interventions.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"214"},"PeriodicalIF":2.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974176","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 interpersonal relationships and forgiveness on post-traumatic growth in hemodialysis patients: a cross-sectional study.","authors":"Yansheng Ye, Qin Xie, Yane Sun, Jianqing Xu, Linan Cheng, Linglin Kong","doi":"10.1186/s12882-025-04141-z","DOIUrl":"https://doi.org/10.1186/s12882-025-04141-z","url":null,"abstract":"<p><strong>Background: </strong>Post-traumatic growth is regarded as a screening indicator for quality of life of hemodialysis patients. Interpersonal relationships and forgiveness of hemodialysis patients may play an important role in improving post-traumatic growth. Few studies reveal the relationship between interpersonal relationships, forgiveness, and post-traumatic growth. This study aimed to explore the relationships among interpersonal relationships, forgiveness, and post-traumatic growth in a sample of hemodialysis patients and analyzed the influencing factors associated with post-traumatic growth in hemodialysis patients.</p><p><strong>Methods: </strong>In a cross-sectional study involving convenience sample from August to October 2022, 369 hemodialysis patients from nine hospitals completed the Interpersonal Relationship Comprehensive Diagnosis Scale, Heartland Forgiveness Scale, Post-traumatic Growth Inventory, and demographic characteristics and clinical information. Data were analyzed using SPSS and multiple linear regression analysis was used to identify the variables associated with the scores of post-traumatic growth.</p><p><strong>Results: </strong>Interpersonal relationships showed a significant negative correlation with forgiveness (r = -0.251, p< 0.01) and a negative correlation with post-traumatic growth (r = -0.112, p = 0.02). A significant positive correlation was found between forgiveness and post-traumatic growth (r = 0.169, p< 0.01). In the regression analysis model, gender (β = 0.195, p< 0.01), marital status (β = 0.156, p< 0.01), number of complications (β =-0.194, p< 0.01), interpersonal relationships (β =-0.098, p= 0.03), and forgiveness (β = 0.127, p= 0.01) impacted post-traumatic growth significantly.</p><p><strong>Conclusions: </strong>There were significant correlations among interpersonal relationships, forgiveness, and post-traumatic growth. Post-traumatic growth in hemodialysis patients was related to gender, marital status, number of complications, interpersonal relationships, and forgiveness. Number of complications, interpersonal relationships, and forgiveness should be monitored and positively managed to improve effects on post-traumatic growth in hemodialysis patients. Nurses should consider implementing interventions with an keynote on controlling complications, ameliorating interpersonal relationships, and increasing forgiveness to help hemodialysis patients improve their post-traumatic growth.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"212"},"PeriodicalIF":2.2,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974174","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 predictive value of renal vascular resistance index and serum biomarkers for sepsis-associated acute kidney injury: a retrospective study.","authors":"Daofeng Huang, Zhaobin Yang, Luzhen Qiu, Jinzhan Lin, Xiaomei Cheng","doi":"10.1186/s12882-025-04131-1","DOIUrl":"https://doi.org/10.1186/s12882-025-04131-1","url":null,"abstract":"<p><strong>Background: </strong>Sepsis-associated acute kidney injury (AKI) presents a significant clinical challenge, necessitating the identification of predictive indicators for early detection and intervention. This retrospective case-control study aimed to investigate the predictive potential of renal vascular resistance index and serum biomarkers in sepsis-associated AKI.</p><p><strong>Methods: </strong>A cohort of 108 patients diagnosed with sepsis was separated into two groups-those with acute kidney injury (AKI) and those without-using the diagnostic criteria established by the kidney disease: Improving Global Outcomes (KDIGO) guidelines. Various demographic, clinical, and laboratory parameters were collected, including renal resistive index, serum biomarkers, disease severity scores, and clinical outcomes. Statistical analyses, including t-tests, correlation analysis, receiver operating characteristic (ROC) analysis, and joint model construction, were conducted to evaluate the predictive value of these parameters.</p><p><strong>Results: </strong>The AKI group exhibited higher APACHE II and SOFA scores compared to the non-AKI group, indicating the association between disease severity scores and the presence of AKI in septic patients. Renal resistive index and several serum biomarkers, including C-reactive protein and procalcitonin, were notably elevated in the AKI group. Correlation analysis demonstrated significant associations between renal vascular resistance index, serological biomarkers, and clinical severity scores. ROC analysis revealed that several parameters, including Renal Resistive Index (AUC = 0.667), C-reactive Protein (CRP, AUC = 0.665), Platelet Count (AUC = 0.666), and Prothrombin Time (AUC = 0.669), demonstrated moderate diagnostic performance for predicting sepsis-associated AKI. These parameters were subsequently incorporated into a joint predictive model, which exhibited robust diagnostic accuracy with an AUC of 0.780, highlighting its potential utility as a reliable predictive tool in clinical practice.</p><p><strong>Conclusions: </strong>The study findings underscore the potential for integrating renal vascular parameters and serum biomarkers in clinical risk stratification and early intervention strategies for sepsis-associated AKI.</p><p><strong>Clinical registration: </strong>Not applicable.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"208"},"PeriodicalIF":2.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12023560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062135","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":"Celastrol modulates damage of renal tissues in Immunoglobulin A nephropathy via targeting TGase-2/HMGB1 signaling pathway.","authors":"Yanping Wu, Ruman Chen, Danfang Deng, Wenjing Wu, Xiaoqin Wang","doi":"10.1186/s12882-025-04139-7","DOIUrl":"https://doi.org/10.1186/s12882-025-04139-7","url":null,"abstract":"<p><strong>Background: </strong>Persistent controversies surround the treatment of Immunoglobulin A nephropathy (IgAN), necessitating the exploration of safer and more effective therapeutic agents. Tripterygium wilfordii, a traditional Chinese medicine, demonstrates promising benefits in reducing proteinuria and enhancing renal function in IgAN. This study aims to elucidate the therapeutic mechanisms of celastrol, a principal medicinal component of Tripterygium wilfordii, in IgAN treatment.</p><p><strong>Methods: </strong>An IgAN rat model was induced using lipopolysaccharide, carbon tetrachloride, and bovine serum albumin. HMCs cells were stimulated by aIgA1 to establish IgAN model in vitro. Immunofluorescence, immunohistochemistry and HE staining were performed using renal tissues. Western Blot and RT-PCR were utilized to measure the protein and mRNA expressions of TGase-2, HMGB1, TLR4, and MYD88 in vivo and in vitro.</p><p><strong>Results: </strong>Celastrol treatment exhibited reduced levels of proteinuria, diminished pathological kidney damage, and decreased expression of TGase-2 and HMGB1 in the renal tissue of IgAN rats. Furthermore, celastrol treatment or TGase-2 knockdown decreased the expression of TGase-2, HMGB1, TLR4, and MYD88 in both proteins and mRNA levels in, and the contents of HMGB1, TNF-α, IL-6, and FN in the in aIgA1 stimulated HMCs.</p><p><strong>Conclusion: </strong>Our study findings provide evidence supporting the efficacy of celastrol in treating IgAN. The potential underlying mechanisms involve the reduction of cell proliferation and inflammatory response by inhibiting the expression of the TGase-2/HMGB1 pathway.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"209"},"PeriodicalIF":2.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12023472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954216","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 protective effects of insulin on the developing of dementia in chronic kidney disease patients with hypertension and diabetes: a population-based nationwide study.","authors":"Yun-Yi Chen, Yi-Hsien Chen, Yu-Wei Fang, Jing-Tong Wang, Ming-Hsien Tsai","doi":"10.1186/s12882-025-04145-9","DOIUrl":"https://doi.org/10.1186/s12882-025-04145-9","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD), hypertension, and diabetes are associated with dementia, and insulin resistance promotes vascular dysfunction resulting in dementia. However, the study of insulin use in preventing dementia in CKD patients with diabetes and hypertension is limited. We aim to assess the effects of insulin use on the incidence of dementia in patients with CKD with hypertension and diabetes.</p><p><strong>Design, setting and participants: </strong>A retrospective cohort study using the nationwide database from Taiwan's National Health Insurance Research Database. We selected 11,758 CKD patients with diabetes and hypertension in 2006, including 5,864 insulin users and 5,894 non-insulin users. Moreover, their medication possession ratios (MPR) were calculated.</p><p><strong>Main outcomes: </strong>We used the competing risk model to estimate the hazard ratio (HR) for the incidence of dementia for insulin use in the target population.</p><p><strong>Results: </strong>In a follow-up period of 11 years, 1285 events of dementia were recorded, and the multivariate-adjusted HR for dementia by insulin usage (yes vs. no) and insulin usage per MPR is 0.652 (95% confidence interval [CI]: 0.552 to 0.771) and 0.995 (95% CI: 0.993 to 0.998) respectively. Such a significant negative association was consistent in almost all subgroups. Moreover, a dose-dependent effect of insulin was noted, where patients with higher insulin MPRs were less likely to have dementia.</p><p><strong>Conclusion: </strong>The CKD patients with hypertension and diabetes who received insulin therapy had a 35% decreased risk of dementia.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"211"},"PeriodicalIF":2.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966245","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":"Factors associated with self-care behavior in patients with chronic kidney disease: a systematic review.","authors":"Mella Riski, Irma Melyani Puspitasari, Cherry Rahayu, Sofa D Alfian","doi":"10.1186/s12882-025-04137-9","DOIUrl":"https://doi.org/10.1186/s12882-025-04137-9","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a significant global health issue associated with cardiovascular risk, elevated morbidity and mortality rates, reduced quality of life, and high medical costs. Self-care behavior (SCB) is an effective strategy for mitigating the negative impacts of CKD. Identifying factors that influence SCB in CKD patients is essential for improving clinical outcomes. This study analyzes the factors affecting self-care behavior in patients with CKD.</p><p><strong>Methods: </strong>A structured search was conducted on PubMed and EBSCO up to June 10th, 2024. This review was not limited by publication year, published in English, and only full-text articles were included.</p><p><strong>Results: </strong>A total of 510 articles were identified from both databases. After removing 109 duplicates, 401 articles remained. Sixteen articles met the inclusion criteria. The results showed that several factors were associated with SCB, including health literacy (HL), social support, disease knowledge (DK), age, occupation, income, marital status, place of residence, gender, education, comorbidities, smoking habits, body mass index, participation in CKD programs, duration since CKD diagnosis, CKD stage, psychological factors, therapy compliance, self-efficacy, and laboratory results (triglyceride, PCR urine, hemoglobin, phosphor, and albumin levels).</p><p><strong>Conclusions: </strong>The findings indicated that multiple factors can influence SCB in patients with CKD. The most factors that showed a significant association with SCB were age and education in 5 studies, respectively. These findings underscore the importance of addressing patient-specific factors to improve patient SBC through education and counseling from healthcare providers.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"210"},"PeriodicalIF":2.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954289","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":"Morphological transition after medical treatment of emphysematous pyelonephritis over time-case report.","authors":"Ukyo Yamamoto, Motoka Yagame, Daisuke Uchida, Masumi Hara, Hideyuki Takeuchi, Hiroo Kawarazaki","doi":"10.1186/s12882-025-04135-x","DOIUrl":"https://doi.org/10.1186/s12882-025-04135-x","url":null,"abstract":"<p><strong>Background: </strong>Emphysematous pyelonephritis (EPN) is a necrotizing infection characterized by the production of gas in the renal parenchyma, collecting system or perirenal tissue. The treatment strategy, especially for surgical intervention, in EPN has been based on the Huang and Wan classifications. Huang's classification is based on the extent of gas and abscess spillover, while Wan's classification is based on the morphology of gas and fluid retention. Wan's classification type I EPN is considered more severe compared to type II EPN and pathophisyological mechanisms are speculated as the cause of the different presentation but the actual cause is unknown. In the present case, conservative treatment of EPN in the early stages of the disease allowed us to show that Wan's classification may represent a time series of morphologic changes throughout EPN.</p><p><strong>Case presentation: </strong>A 72-year-old woman treated for diabetes was admitted because of suspected treatment-resistant pyelonephritis. Her CT scan at presentation was suggestive of EPN and antibiotics was started. After additional medical treatment, a follow-up of CT image showed that the initial appearance of bubbly gas formation changed into a fluid-forming abscess. This transition shows that type I is an early phase image of EPN and type II image is seen following the early phase. Thereafter no change was seen in CT image and residing inflammation led to planned nephrectomy on day 35. Antibiotics were discontinued and no recurrence was confirmed.</p><p><strong>Conclusions: </strong>Wan's type I and II EPN has been often reported as different pathophysiological entities. Our case shows that these two subtypes may represent stages in the progression of EPN. Medical treatment for type I may permit safe nephrectomy for type II EPN.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"207"},"PeriodicalIF":2.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12023580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963067","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":"Circulating bile acid profiles characteristics and the potential predictive role in clear cell renal cell carcinoma progression.","authors":"Qi-Chao Wang, Jing-Yi Cao, Guang-Yue Wang, Heng Wang, Hua Peng, Qian Wang, Zhi-Xiang Yin, Jie-Zhou, Ping-An Chang, Gui-Hua Zhang, Wen-Tao Yao, Jia-Cheng Wu, Chang-Song Pei","doi":"10.1186/s12882-025-04142-y","DOIUrl":"https://doi.org/10.1186/s12882-025-04142-y","url":null,"abstract":"<p><strong>Background: </strong>The incidence of clear cell renal cell carcinoma (ccRCC) has steadily increased over the past decade, and recent studies have linked bile acid (BA) metabolism to its development. However, the metabolic profile of BAs and their potential as biomarkers in ccRCC pathogenesis remain poorly characterized, making their evaluation crucial for advancing disease understanding and management.</p><p><strong>Methods: </strong>A total of 68 newly diagnosed ccRCC patients and 63 healthy controls were enrolled. Serum bile acid (BA) profiles were measured using Ultra Performance Liquid Chromatography-Tandem Mass Spectrometry (UPLC-MS/MS). The Orthogonal Projections to Latent Structures Discriminant Analysis (OPLS-DA) model analyzed differences in serum BA profiles between ccRCC patients and controls. Additionally, the relationship between BA profiles and tumor heterogeneity parameters was investigated. Receiver Operating Characteristic (ROC) analysis identified potential biomarkers for ccRCC pathogenesis.</p><p><strong>Results: </strong>The BA profile was altered in ccRCC patients and was not influenced by sex or age. Specifically, primary and secondary unconjugated BA fractions were significantly higher in the ccRCC population. Five BA metabolite candidates exhibited the most significant differences between ccRCC patients and controls. Deoxycholic acid (DCA) was associated with pathological pTNM stage classification and grade. Chenodeoxycholic acid (CDCA) and lithocholic acid (LCA), combined with testosterone, showed potential as biomarkers for the pathogenesis of ccRCC.</p><p><strong>Conclusion: </strong>Alterations in the serum BA profile are observed in ccRCC. Deoxycholic acid (DCA) correlates with pathological pTNM stage classification and tumor grade. Additionally, CDCA combined with LCA show potential as biomarkers for ccRCC pathogenesis.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"206"},"PeriodicalIF":2.2,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961095","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":"Treatment of insomnia, restless legs, cramps, and pain associated with chronic kidney disease: results from a multinational survey of kidney supportive care practice.","authors":"Kurinji Nalankilli, Elizabeth Stallworthy, Kathryn Ducharlet, Barnaby D Hole, Daniel V O'Hara, Neeru Agarwal, Charlotte M Snead, Fergus J Caskey, Brendan Smyth","doi":"10.1186/s12882-025-04107-1","DOIUrl":"10.1186/s12882-025-04107-1","url":null,"abstract":"<p><strong>Background: </strong>Kidney failure is associated with a high symptom burden, yet few studies describe real-world management approaches.</p><p><strong>Methods: </strong>Kidney care units in Australia, New Zealand (NZ) and the United Kingdom (UK) were surveyed regarding their pharmacological treatment of a range of common symptoms affecting those with kidney failure. The present report describes the results for insomnia, restless legs syndrome (RLS), cramps, and pain. Variation in responses was described using normalised generalised variance (NGV), resulting in a score from 1 (most diverse) to 0 (least diverse).</p><p><strong>Results: </strong>One hundred and twelve (of 171 contacted) kidney units responded, including 56 units in Australia (50%), 7 in NZ (6%), and 49 in the UK (44%). Diversity of practice was highest for insomnia (mean NGV 0.95, range 0.93-0.98), where melatonin was the leading first-line agent (38%), followed by zolpidem and zopiclone (29%). Diversity of practice was lowest for RLS (mean NGV 0.66, range 0.30-0.99), owing to widespread use of iron replacement as first line (69%), gabapentinoids (45%), and dopamine agonists (37%). Diversity of practice was moderate for neuropathic pain (mean NGV 0.71, range 0.44-0.93), cramps (mean NGV 0.72, range 0.48-0.97), and opioids (mean NGV 0.88, range 0.75-0.97). Numerous significant between-country differences in treatment preferences were noted.</p><p><strong>Conclusions: </strong>There is wide variation in treatment approaches to common symptoms affecting people living with advanced CKD or kidney failure, both within and between countries, indicating a need for evidence-based guidelines and further randomised studies to inform practice.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"204"},"PeriodicalIF":2.2,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969495","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}