BMC Nephrology最新文献

{"title":"Prognosis comparison in chronic kidney disease stages 4-5 patients with low parathyroid hormone level due to different causes.","authors":"Xiao Zhang, Junzhe Chen, Yi Lu, Sha Fu, Chun Ye, Hai Huang, Qiang Liu, Sheng Nie, Ying Tang","doi":"10.1186/s12882-026-05202-7","DOIUrl":"10.1186/s12882-026-05202-7","url":null,"abstract":"<p><strong>Background: </strong>Existing studies have focused on secondary hyperparathyroidism with elevated PTH in CKD, but survival outcomes of CKD patients with low PTH remain underexplored. This study examines prognostic implications of PTH reduction from different etiologies.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study included CKD stages 4-5 patients with PTH < 150 pg/mL from the China Renal Data System, categorized into parathyroidectomy (PTX), Drug, and Unknown Causes (UC) groups based on low PTH etiology. Mortality was analyzed using Kaplan-Meier curves and Cox regression. Covariates were selected by univariate or LASSO regression. Inverse probability weighting was applied in sensitivity analyses to reduce confounding.</p><p><strong>Results: </strong>A total of 17 175 patients were included: 423 in the PTX group, 10 519 in the Drug group, and 6 233 in the UC group. PTX group had the highest survival rate (79.44%) and lowest cardiovascular mortality (1.61%), followed by Drug group (69.21% and 4.60%) and UC group (50.76% and 9.83%) (all P < 0.01). Both Drug group and UC group were consistently associated with significantly higher mortality risk compared with the PTX group (both P < 0.05). After applying IPW to balance key covariates, PTX group remained associated with the lowest mortality risk (both P < 0.05). However, in some sensitivity analyses, no significant difference was observed between PTX group and Drug group.</p><p><strong>Conclusions: </strong>Pharmacological therapy and PTX were associated with more favorable survival profiles than low PTH of unknown causes in patients with advanced CKD, though residual confounding due to baseline differences between groups cannot be fully excluded.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468993","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":"Rheopheresis in hemodialysis patients with limb ulcers or amputation: safety and outcomes from a multicenter cohort.","authors":"Yuri Bonsante, Cyril Ferdynus, Ehshaneraza Asgarali, Ludovic Di Ascia, Henri Vacher-Coponat, Asma Allal, Anabelle Baillet, Gabriel Gruget, Stéphanie Delelis, Reuben Veerapen, Julien Gayon, Hamza Naciri Bennani, Arnaud Le Flecher","doi":"10.1186/s12882-026-05186-4","DOIUrl":"10.1186/s12882-026-05186-4","url":null,"abstract":"<p><strong>Background: </strong>Limb ulcers are common in hemodialysis (HD) and often have a poor prognosis despite standard care. Rheopheresis is a plasmapheresis technique that reduces blood viscosity and erythrocyte aggregation and has been proposed as an adjunctive therapy, but no study has yet compared it to standard care alone.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter study comparing 61 hemodialysis (HD) patients treated with rheopheresis for limb ulcer or amputation in five French dialysis centers with 119 HD patients receiving standard care matched on age, lesion type, and lesion site. Outcomes were analyzed using propensity score-matched cohorts. The primary outcome was 1-year amputation-free survival (AFS).</p><p><strong>Results: </strong>One-year AFS reached 58.9% (95% CI: 45.1; 70.4) in the rheopheresis cohort and 28.8% (95% CI: 20.9; 37.2) in the standard care cohort. This difference did not reach statistical significance after adjustment for immortal-time bias (HR: 1.28, 95% CI: 0.72-2.25). Secondary outcomes followed similar trends, slightly in favor of rheopheresis without reaching significance. Major adverse events occurred in only 2.4% of rheopheresis sessions, and no treatment-related deaths were reported.</p><p><strong>Conclusions: </strong>Rheopheresis was well tolerated and demonstrated a favorable safety profile. Clinical outcomes were numerically better with rheopheresis compared to standard care, although differences did not reach statistical significance. These findings suggest a potential benefit, warranting larger prospective studies.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468988","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":"Comparative efficacy and safety of anticoagulation strategies in continuous renal replacement therapy: a real-world cohort study.","authors":"Qing Ou, Dan He, Wenjuan Yan, Xiuying Shi, LengZhen Zhang, Li Tang, Yucheng Li, Zhiyong Fan, Yanan Liu, Ranghui Yu","doi":"10.1186/s12882-026-05197-1","DOIUrl":"10.1186/s12882-026-05197-1","url":null,"abstract":"<p><strong>Background: </strong>The optimal anticoagulation strategy for continuous renal replacement therapy (CRRT) remains controversial. Real-world comparisons of contemporary agents-regional citrate anticoagulation (RCA), nafamostat mesylate (NM), and unfractionated heparin (UH)-are limited.</p><p><strong>Methods: </strong>In this single-center retrospective cohort study, we analyzed 420 CRRT sessions (from 197 unique patients) conducted in four intensive care unit (ICU) wards at an academic medical center in China between September 2025 and November 2025. The primary efficacy outcome was filter lifespan, with Restricted Mean Survival Time (RMST) analysis adopted as the primary method (due to violation of the proportional hazards assumption). Propensity score matching (PSM) and mixed-effects Cox models were used as sensitivity analyses, adjusting for patient, treatment, ward, and machine factors. Multiplicity adjustment (Holm-Bonferroni) was applied for pairwise comparisons.</p><p><strong>Results: </strong>Among 420 sessions, RCA was the most frequently used approach (59.0%), followed by NM (21.2%), UH (12.6%), and no anticoagulation (4.0%). Median filter lifespan was longest with RCA (65.5 h, IQR 48.0-72.0) compared to NM (32.0 h, IQR 15.5-52.5), UH (40.0 h, IQR 26.0-72.0), and no anticoagulation (12.5 h, IQR 6.0-19.5; P < 0.001). RMST analysis confirmed that RCA was associated with significantly longer mean filter survival time compared to NM (difference 18.2 h, 95% CI 10.5-25.9; adjusted P < 0.001) and UH (difference 14.6 h, 95% CI 5.8-23.4; adjusted P = 0.046). The NM vs. UH comparison showed no significant difference (difference - 3.6 h, 95% CI -12.1 to 4.9; adjusted P = 0.52). After PSM, results remained consistent. Major bleeding events were rare (n = 9, 2.1%), but the small number of events precludes meaningful between-group safety comparison. However, 20.9% of RCA sessions failed to achieve the protocol-specified post-filter ionized calcium target, reflecting a metabolic calcium monitoring challenge unique to citrate anticoagulation. Twenty-eight-day mortality (patient-level analysis, n = 197) did not differ significantly across groups after adjustment (overall 36.5%, 72/197).</p><p><strong>Conclusion: </strong>In this retrospective data analysis of real-world practice, RCA provided superior filter lifespan compared to NM and UH for CRRT, while NM showed intermediate efficacy. Although major bleeding events were uncommon, the small number of events precludes definitive safety conclusions. Vigilant monitoring remains necessary regardless of the agent employed. The choice of anticoagulation should balance filter efficacy, bleeding risk, metabolic monitoring capabilities, and institutional resources.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469020","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":"Concurrent κ light chain proximal tubulopathy and crystal-storing histiocytosis in monoclonal gammopathy of renal significance: a rare case report with 4-year follow-up and literature review.","authors":"Changxiu Guo, Rui Xue, Qinghui Zhou, Qijun Wan, Xiuli Zhang","doi":"10.1186/s12882-026-05155-x","DOIUrl":"10.1186/s12882-026-05155-x","url":null,"abstract":"<p><strong>Background: </strong>Light chain proximal tubulopathy (LCPT) and crystal-storing histiocytosis (CSH) are rare forms of monoclonal immunoglobulin-associated kidney disease, representing either variants of monoclonal gammopathy of renal significance (MGRS) or renal complications of multiple myeloma (MM). Concurrent LCPT and suspected CSH associated with κ light chain MGRS is exceptionally rare, with only three comparable cases reported worldwide. This CARE guideline-compliant report describes the clinical, laboratory and histopathological features of this rare dual renal lesion.</p><p><strong>Case presentation: </strong>A 61-year-old Chinese woman presented with Fanconi syndrome (FS), chronic kidney disease (CKD) and isolated tubular proteinuria. Serum and urine immunofixation electrophoresis showed elevated monoclonal IgGκ. Bone marrow examination revealed mild plasmacytosis (< 10%), with no hypercalcemia, myeloma bone lesions, cast nephropathy or SLiM criteria-defined myeloma events, confirming MGRS and excluding MM and smoldering multiple myeloma (SMM).</p><p><strong>Diagnostic assessment: </strong>Renal biopsy electron microscopy demonstrated dense crystalline inclusions in proximal tubular epithelial cells and interstitial histiocytes. Immunohistochemistry and immunoelectron microscopy confirmed strong κ light chain restriction. These findings are highly suggestive of concurrent LCPT and crystal-storing histiocytosis (CSH). However, definitive confirmation of CSH by CD68 immunohistochemistry-the gold standard for histiocytic lineage identification-could not be performed due to exhaustion of the limited archival biopsy tissue. This case is therefore reported as \"CSH suspected based on ultrastructural and immunoelectron microscopy criteria.</p><p><strong>Intervention and outcome: </strong>The patient received first-line CyBorD (cyclophosphamide, bortezomib, and dexamethasone) chemotherapy, achieving partial hematological remission (PR) and marked improvement of Fanconi syndrome. Renal function remained normal and stable throughout the 48-month follow-up period.</p><p><strong>Conclusions: </strong>We report this rare κ light chain MGRS case with concurrent LCPT and suspected CSH, which showed favorable responses to CyBorD with durable renal stability. This case highlights integrated diagnostic strategies and boosts clinical awareness of this rare monoclonal gammopathy-related renal injury.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454535","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":"Kidney histopathology associated with kidney function at 1 year post severe AKI related to ANCA-associated vasculitis.","authors":"Léonard Cauchy, Pierre Raynaud, Pascal Reboul, Sylvain Cariou, Sophie Renaud, Émilie Pambrun, Pedram Ahmadpoor, Laurent Daniel, Hélène Perrochia, Camille Dubart, Sébastien Canet, Olivier Moranne, Florian Garo","doi":"10.1186/s12882-026-05189-1","DOIUrl":"10.1186/s12882-026-05189-1","url":null,"abstract":"<p><strong>Introduction: </strong>ANCA-associated vasculitis is a rare autoimmune disease, and is particularly serious when the kidneys are involved. In addition to immunosuppressants, plasma exchanges are used to treat severe forms of vasculitis. The international guidelines recommend kidney biopsies for their diagnostic and prognostic roles. The Berden, ARRS (ANCA Renal Risk Score), and AKRiS (ANCA Kidney Risk Score) classifications show that certain histological lesions, such as interstitial fibrosis, tubular atrophy, and the percentage of normal glomeruli negatively impact kidney prognosis. The aim of this study was to evaluate the renal response of patients with severe forms of ANCA-associated vasculitis undergoing kidney biopsy and plasma exchanges, to identify the histological determinants favorable to kidney recovery.</p><p><strong>Method: </strong>This was a retrospective multicenter study of 34 patients with ANCA-associated vasculitis with severe kidney involvement who were receiving plasma exchanges. The primary endpoint was death, the need for dialysis, or persistent kidney dysfunction (eGFR < 30 ml/min/1.73 m² for 3 months) at one year.</p><p><strong>Results: </strong>Among the 34 patients (56% men), 19 (55%) met the primary endpoint. The 15 patients with an eGFR > 30 ml/min/1.73 m² at one year were younger (60 vs. 70 years), mostly male (73% vs. 42%), and had higher CRP levels (107 vs. 32 mg/l). Histologically, this group had more normal glomeruli (25% vs. 11%), less glomerulosclerosis (15% vs. 22%), and more cellular and partial crescents.</p><p><strong>Conclusion: </strong>Patients treated by therapeutic plasmapheresis with a better kidney prognosis at 1-year had more normal glomeruli, less glomerulosclerosis and was associated with higher CRP. These results could support the systematic use of kidney biopsies for severe forms of ANCA-associated vasculitis, to better adapt treatments.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444493","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 preoperative isometric hand exercise on vascular caliber in patients with advanced chronic kidney disease - a randomised controlled trial.","authors":"Nawaphan Taengsakul, Phornpa Lertutsahakul, Pantita Pooloui, Mullika Buttakosa","doi":"10.1186/s12882-026-05200-9","DOIUrl":"10.1186/s12882-026-05200-9","url":null,"abstract":"<p><strong>Background: </strong>Arteriovenous fistula (AVF) remains the preferred vascular access for hemodialysis, yet maturation failure is common and preoperative strategies to optimize vessel caliber are poorly standardized. This study hypothesizes that isometric exercise, when implemented preoperatively can enhance vascular caliber, thereby improving AVF creation and maturation.</p><p><strong>Methods: </strong>This single-center, prospective randomized controlled trial enrolled 54 patients with CKD stage 4-5 scheduled for vascular access creation at Chulabhorn Hospital, Bangkok. Participants were allocated 1:1 to an 8-week isometric exercise regimen (grip strengthener and pétanque ball; n = 27) or control (n = 27). Vascular caliber was assessed by duplex ultrasound at baseline, 4, and 8 weeks. The primary outcome was change in cephalic vein arm diameter at 8 weeks. Secondary outcomes included changes in other vessel diameters, grip strength, AVF feasibility, AVF type, and 12-week maturation rate.</p><p><strong>Results: </strong>Baseline characteristics were comparable except for higher CAD prevalence (44.4% vs. 18.5%, p = 0.040) and antiplatelet use (40.7% vs. 14.8%, p = 0.033) in the control group. The exercise group demonstrated a significant increase in cephalic vein arm diameter at 8 weeks (p = 0.045). Radiocephalic AVF creation was significantly more frequent in the exercise group (93.8% vs. 58.3%, p = 0.026). Baseline cephalic vein arm diameter was the strongest independent predictor of AVF feasibility (adjusted OR = 3.63 per mm, 95% CI [1.56, 8.47], p = 0.003). AVF maturation rates did not differ significantly between groups.</p><p><strong>Conclusion: </strong>An 8-week preoperative isometric exercise protocol significantly improved cephalic vein arm diameter and increased radiocephalic AVF creation rate, a clinically meaningful shift that preserves proximal venous capital for future vascular access procedures. No significant difference in short-term AVF maturation was observed, likely reflecting the premature 12-week follow-up and composition effect of more radiocephalic procedures in the exercise group; adequately powered trials with extended follow-up are warranted.</p><p><strong>Trial registration: </strong>The study was registered with the Thai Clinical Trial Registry (number: 20230913004) on 13 September 2023.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13545763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435127","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: Gut microbiota dysbiosis in intensive care unit patients with acute kidney injury: insights from 16S sequencing and mediation analysis.","authors":"Jiao Li, Yan Shi, Haining Meng, Fengdi Fu, Yan Wang, Yan Qu","doi":"10.1186/s12882-026-05176-6","DOIUrl":"10.1186/s12882-026-05176-6","url":null,"abstract":"","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435140","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":"Impaired fatty acid metabolism in AKI: experimental evidence - a narrative review.","authors":"Johanna Gruzla, Stefan Erfurt, Benedikt Marahrens, Karsten-Henrich Weylandt, Oliver Ritter, Daniel Patschan","doi":"10.1186/s12882-026-05166-8","DOIUrl":"10.1186/s12882-026-05166-8","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a common and serious complication of hospitalized patients worldwide. In most cases, the syndrome is characterized by dysfunction/structural damage of the tubular epithelial cells. The metabolic feature is a reduction in cellular adenosine triphosphate (ATP) synthesis as a result of decreased fatty acid oxidation. Stabilization of the fatty acid (FA) oxidation process may influence the course of AKI, whether caused by endogenous or exogenous factors. In this narrative review, we discuss experimental evidence on the modulation of fatty acid metabolism in AKI.</p><p><strong>Methods: </strong>Narrative review article. The following databases were searched for references: PubMed, Web of Science, Cochrane Library, Scopus. The period lasted from 2010 until May 2026.</p><p><strong>Results: </strong>Finally, 16 articles on the modulation of fatty acid metabolism in experimental AKI were identified. Disturbances in the FA oxidation process are associated with an aggravation of renal dysfunction in AKI, and lipids accumulate in the renal tissue itself. The consequences of exogenous fatty acid intake depend on the structural characteristics of the metabolites applied, as well as on the pattern of renal damage and the relevant pathophysiological processes.</p><p><strong>Conclusions: </strong>Under certain conditions, adequate fatty acid oxidation may be considered nephroprotective; however, the complexity of the syndrome's pathophysiology must always be taken into account. Distinct fatty acids have the potential to offer therapeutic benefits in AKI cases. However, the efficacy of an FA-based therapeutic approach depends on two main factors: the chemical structure of the substances used and the nature of the underlying kidney disease.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435142","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":"Personalized survival prediction in elderly dialysis patients: integrating machine learning with traditional survival analysis.","authors":"Manuel Huerfano, Elina Huerfano, Natalia Piragauta, Mauricio Sanabria","doi":"10.1186/s12882-026-05121-7","DOIUrl":"10.1186/s12882-026-05121-7","url":null,"abstract":"<p><strong>Background: </strong>Elderly patients undergoing kidney replacement therapy (KRT) face high mortality rates. Traditional statistical models describe overall survival patterns but may fail to capture non-linear relationships among clinical factors. This study integrates classical survival analysis and machine learning (ML) to enhance individualized survival prediction in elderly patients treated with hemodialysis (HD) or peritoneal dialysis (PD).</p><p><strong>Methods: </strong>We analyzed a retrospective cohort of 2,501 patients aged ≥ 75 years initiating KRT in Colombia (2009-2013), with follow-up through 2015. Survival was assessed using Kaplan-Meier and Cox proportional hazards (Cox PH) models. Five ML survival methods including Penalized Cox, Random Survival Forest (RSF), gradient boosting accelerated failure time (XGB-AFT), DeepSurv, and DeepHit were evaluated on an independent test set using time-dependent concordance (C-index) and the integrated Brier score (IBS). Uncertainty was quantified using non-parametric bootstrap 95% confidence intervals.</p><p><strong>Results: </strong>HD was associated with improved survival compared with PD (HR = 1.36, 95% CI: 1.20-1.53; p < 0.005). Predictors of reduced survival included advanced age, female sex, diabetes, hypoalbuminemia, and anemia. In head-to-head model comparison, DeepSurv achieved the best overall performance (C-index = 0.692, 95% CI: 0.649-0.734; IBS = 0.145, 95% CI: 0.129-0.164), while Cox-based models showed comparable performance. RSF and XGB-AFT demonstrated intermediate performance, and DeepHit showed lower overall accuracy in this cohort. Feature importance analysis highlighted vascular access (arteriovenous fistula), albumin, and age as the strongest predictors.</p><p><strong>Conclusions: </strong>Hemodialysis is associated with a survival advantage in elderly dialysis patients. Integrating ML with classical survival analysis improves individualized prognostic assessment and highlights prognostic factors such as vascular access and nutritional/inflammatory status. These findings may inform precision medicine approaches to dialysis planning and patient-centered management.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435130","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 kidney failure receiving dialysis: a hospital-based cross-sectional study in Bandung, Indonesia.","authors":"Mella Riski, Irma Melyani Puspitasari, Cherry Rahayu, Sofa D Alfian","doi":"10.1186/s12882-026-05196-2","DOIUrl":"10.1186/s12882-026-05196-2","url":null,"abstract":"<p><strong>Background: </strong>While self-care behaviors (SCB) are recognized as a crucial component of managing the adverse effects associated with chronic kidney disease (CKD), understanding of the factors influencing SCB remains limited, particularly in resource-constrained settings like Indonesia. This study aims to measure SCB scores and identify factors associated with SCB in patients with kidney failure receiving dialysis.</p><p><strong>Methods: </strong>Data collection was carried out at a tertiary hospital in Bandung, Indonesia, from September to November 2024. This study used three questionnaires that assessed SCB, health literacy (HL), and disease knowledge (DK) with a total of 43 items. The dependent variable was the SCB score. The independent variables included HL, DK, age, gender, marital status, education, income, occupation, comorbidities, body mass index (BMI), blood pressure, dialysis status, duration of dialysis, type of medication, route of drug administration, and number of medications. Data were analyzed using descriptive, univariate, and multivariate linear regression.</p><p><strong>Results: </strong>A total of 110 patients were enrolled, of whom 109 were receiving dialysis and one was not. The SCB score of patients with kidney failure receiving dialysis varied, with an average score of 57.5 ± 8.94 (range: 16-80). Factors significantly associated with high SCB scores were high DK (β = 7.992; p = 0.003), female (β = 4.235; p = 0.012), and income ≥ Indonesian RMW (Regional Minimum Wage) (β = 4.946; p = 0.029).</p><p><strong>Conclusions: </strong>A higher SCB score indicates an improvement in the patient's SCB. DK, gender, and income were independently associated with SCB. Healthcare providers need to implement education and counseling to improve SCB by considering these characteristics.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435149","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}