BMC Nephrology最新文献

{"title":"Health-related quality of life in hypertensive patients with chronic kidney disease in low and middle-income countries.","authors":"Wening Wulandari, Neily Zakiyah, Cherry Rahayu, Irma M Puspitasari, Auliya A Suwantika","doi":"10.1186/s12882-025-03957-z","DOIUrl":"10.1186/s12882-025-03957-z","url":null,"abstract":"<p><p>Hypertension and chronic kidney disease (CKD) are interconnected conditions that can significantly affect a person's health-related quality of life (HRQoL). In low- and middle-income countries (LMICs), this disease burden is heightened due to limited health resources and socio-economic challenges. Based on the available literature, this narrative review aims to discuss the HRQoL of hypertensive patients with CKD in LMICs by identifying the current challenges and providing insights into the strategic potential to improve patient's quality of life. This review reveals that the hypertensive population with CKD has a much lower HRQoL than the general population. Various factors, including physical limitations, comorbidities, psychological barriers, logistical challenges, and social support, can influence HRQoL. Limited access to health care, inadequate resources, and a lack of skilled personnel in LMICs further exacerbate these individual challenges. The economic impact of decreased work productivity and increased health costs adds to the disease burden. Improved health access, effective self-management strategies, and social support are needed to improve HRQoL in hypertensive patients with CKD.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"34"},"PeriodicalIF":2.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999991","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":"Lifetime progression of IgA nephropathy: a retrospective cohort study with extended long-term follow-up.","authors":"Mariell Rivedal, Ole Petter Nordbø, Yngvar Lunde Haaskjold, Rune Bjørneklett, Thomas Knoop, Øystein Eikrem","doi":"10.1186/s12882-025-03958-y","DOIUrl":"10.1186/s12882-025-03958-y","url":null,"abstract":"<p><strong>Background: </strong>IgA nephropathy (IgAN) exhibits an unpredictable trajectory, creating difficulties in prognostication, monitoring, treatment, and research planning. This study provides a comprehensive depiction of the progression of kidney function throughout the disease course, from diagnosis to a span of 36 years post-diagnosis.</p><p><strong>Methods: </strong>We utilized a cohort of 400 Norwegian IgAN patients, from diagnosis to the occurrence of death, initiation of kidney replacement therapy (KRT), or the latest follow-up. Recorded proteinuria (n = 2676) and creatinine (n = 8738) measurements were retrieved. Patients were divided into subgroups based on their specific estimated glomerular filtration rate (eGFR) slopes.</p><p><strong>Results: </strong>Median follow-up was 16 years. During this period, 34% of patients either died or initiated KRT. Among patients who reached endpoint, the median duration from diagnosis to the initiation of KRT or death was 8 years. Notably, 34% of the cohort exhibited a stable disease course, characterized by an eGFR decline of less than 20% between two consecutive measurements. Differences in subsequent disease trajectories among two subgroups with similar eGFR levels at diagnosis could not be accounted for by variations in treatment strategies. Among patients with proteinuria < 1 g/24 h in less than half of the measurements, KRT was five times more prevalent compared to those with more than half of the measurements recording proteinuria < 1 g/24 h (p-value = 0.001).</p><p><strong>Conclusions: </strong>While a significant proportion of IgAN patients reach kidney failure within their lifetimes, outcomes vary widely. Clinical data at diagnosis offer limited insights into long-term risks. Enhanced risk stratification necessitates data collection at multiple time points.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"32"},"PeriodicalIF":2.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999994","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 utility of split function testing in determining recovery of glomerular filtration rate after living kidney donation: a cohort study.","authors":"Kirsty J Crowe, Siobhan K McManus, Julie A Glen, Karen S Stevenson, Ian M McLaughlin, Alice Nicol, Colin C Geddes","doi":"10.1186/s12882-025-03956-0","DOIUrl":"10.1186/s12882-025-03956-0","url":null,"abstract":"<p><strong>Background: </strong>A number of UK transplantation centres use isotope studies to estimate the relative contribution from each kidney in living kidney donor assessment. The evidence that the estimation of pre-donation split function of the non-donated kidney influences post-donation renal recovery is limited. The aim of this study was to analyse whether, in the context of other donor factors, the split function of the non-donated kidney predicts the percentage recovery of glomerular filtration rate (GFR) at one-year post-donation.</p><p><strong>Methodology: </strong>A retrospective cohort analysis was undertaken on 291 living kidney donors in the Glasgow Renal and Transplant Unit between 1^st January 2011 and 1^st June 2022. Univariable and multivariable linear regression analysis was used to analyse the impact of donor factors on recovery of renal function at one year relative to baseline isotope GFR (iGFR) or to estimated GFR (eGFR by Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] formula). Sub-analyses of donor outcome (% recovery of iGFR and eGFR at one year) were undertaken using single-measures ANOVA and grouping of donors by pre-donation isotope uptake of the non-donated kidney.</p><p><strong>Results: </strong>Median recovery of pre-donation GFR at 1 year was 70.0% (IQR 64.8-75.5). On linear regression analysis there was no significant association found between split function of the non-donated kidney and the percentage recovery of iGFR, although a small significant association was found for eGFR. There was no significant difference between mean iGFR or eGFR recovery on sub-analysis of donor outcomes.</p><p><strong>Conclusions: </strong>This study demonstrated no clinically important predictive relationship between percentage recovery of renal function at 1 year after living kidney donation and pre-donation split function within the range accepted for donation in our centre.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"31"},"PeriodicalIF":2.2,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999951","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":"Characterization of diabetic kidney disease in 235 patients: clinical and pathological insights with or without concurrent non-diabetic kidney disease.","authors":"Mengjie Jiang, Hongyu Chen, Jing Luo, Jinhan Chen, Li Gao, Qin Zhu","doi":"10.1186/s12882-024-03931-1","DOIUrl":"10.1186/s12882-024-03931-1","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to explore the clinical and pathological features of patients with diabetic kidney disease (DKD), with and without non-diabetic kidney disease (NDKD), through a retrospective analysis. The objective was to provide clinical insights for accurate identification.</p><p><strong>Methods: </strong>A retrospective analysis of 235 patients admitted to the Department of Nephrology at Hangzhou Hospital of Traditional Chinese Medicine was conducted between July 2014 and December 2022. These patients underwent renal biopsy and received a pathology-based diagnosis of DKD. They were categorized into the DKD alone group (93 cases) and the DKD + NDKD group (142 cases).</p><p><strong>Results: </strong>In the DKD alone group, gender distribution was even, with ages mainly between 50 and 59 years, and a disease duration of less than 5 years, primarily presenting nodular diabetic glomerulosclerosis. In contrast, the DKD + NDKD group had a higher male incidence, a wider age range, longer disease duration, and prevalent diffuse diabetic glomerulosclerosis. Acute and chronic tubulointerstitial lesions and IgA nephropathy were the predominant types of combined NDKD, accounting for 40.14% and 35.21%, respectively. Clinical correlation analysis revealed associations between glomerular grading, tubulointerstitial lesions, renal arteriolar vitelliform lesions, renal vascular atherosclerosis, and clinical parameters such as 24-hour urine protein, hemoglobin, and urinary specific gravity. Multifactorial logistic regression analysis identified independent factors affecting DKD + NDKD, including body mass index, blood creatinine level, microscopic erythrocyte grade, urinary immunoglobulin G/creatinine ratio, and serum immunoglobulin A.</p><p><strong>Conclusion: </strong>The research underscores distinctions in age, gender distribution, disease duration, and renal pathology between DKD alone and DKD + NDKD groups. Additionally, significant discriminative factors including BMI, blood creatinine level, microscopic erythrocyte grade, UIgG/urine creatinine ratio, and serum IgA levels help differentiate DKD from NDKD, thereby enabling personalized treatment approaches. Furthermore, the study highlights the role of RASi as the most commonly used drug in the treatment of both DKD and NDKD, with emerging drugs such as SGLT2 inhibitors showing promising renal protective effects.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"29"},"PeriodicalIF":2.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999988","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":"Screening and prognostic roles of renal volumetry and scintigraphy in the assessment of living kidney transplant donors, considering the early recovery of the residual renal function.","authors":"Shunta Hori, Mitsuru Tomizawa, Kuniaki Inoue, Tatsuo Yoneda, Kenta Onishi, Yosuke Morizawa, Daisuke Gotoh, Yasushi Nakai, Makito Miyake, Kazumasa Torimoto, Nobumichi Tanaka, Kiyohide Fujimoto","doi":"10.1186/s12882-024-03850-1","DOIUrl":"10.1186/s12882-024-03850-1","url":null,"abstract":"<p><strong>Background: </strong>The existing criteria for living kidney donors (LKDs)in Japan are controversial. We evaluated the roles of computed tomography volumetry (CTV) and 99 m Tc-diethylenetriamine penta-acetic acid (DTPA) scintigraphy in assessing preoperative and postoperative renal function and predicting early recovery of residual renal function.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical charts of 175 consecutive LKDs who underwent donor nephrectomy (DN) at our institution between 2006 and 2022. Preoperative renal volume was assessed using enhanced CTV, and screening of renal functions was performed using 99 m Tc-DTPA scintigraphy. We evaluated the estimated glomerular filtration rate (eGFR), single-kidney eGFR (skeGFR), and recovery rate three months after DN.</p><p><strong>Results: </strong>We included 55 men and 81 women (median age, 59 years; median follow-up period, 73 months). Age > 60 years, hypertension, and total kidney volume/body surface area (TKV/BSA) < 170 mL/m² independently predicted preoperative eGFR < 80 mL/min/1.73 m², whereas total measured GFR < 80 mL/min/1.73 m² independently predicted preoperative eGFR < 70 mL/min/1.73 m². Regarding postoperative renal function, residual KV/BSA < 85 mL/m² and ΔskeGFR ≤ 9 mL/min/1.73 m² independently predicted postoperative eGFR < 60% of preoperative eGFR, and TKV/BSA < 170 mL/m² independently predicted early recovery of skeGFR.</p><p><strong>Conclusions: </strong>CTV may be used as a reliable prognostic screening tool to select LKDs and assess their split renal functions before DN, and renal scintigraphy may help select the optimal LKD.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"28"},"PeriodicalIF":2.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999950","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":"Blood pressure control with active ultrafiltration measures and without antihypertensives is essential for survival in hemodiafiltration and hemodialysis programs for patients with CKD: a prospective observational study.","authors":"Franklin Geovany Mora-Bravo, Pamela Tatiana Morales Torres, Nelson Rojas Campoverde, Guillermina Lucía Blum Carcelen, Juan Cristobal Santacruz Mancheno, Ángel Cristóbal Santacruz Tipanta, Hector Perez-Grovas, Willan Patricio Robles Abarca","doi":"10.1186/s12882-025-03948-0","DOIUrl":"10.1186/s12882-025-03948-0","url":null,"abstract":"<p><strong>Background: </strong>High blood pressure is a prevalent condition in patients with chronic kidney disease on hemodialysis. Adequate control of high blood pressure is essential to reducing deaths in this group. The present study aimed to observe mortality prospectively in a group of patients in hemodialysis and hemodiafiltration programs in whom the use of antihypertensives was optimized with the point-of-care dry weight (POC-DW) technique.</p><p><strong>Methods: </strong>The present observational, prospective study was carried out at the Pafram hemodiafiltration unit in Morona Santiago, Ecuador, and the hemodialysis unit of the Fundación Renal del Ecuador in Guayaquil, Ecuador, from August 2019 to December 2023. Patients who were receiving hemodiafiltration were included. Weight was optimized with POC-DW for eight weeks. In Group 1, patients whose use of antihypertensive drugs was not required to control systolic blood pressure with a value less than 150 mmHg predialysis, less than 130 mmHg postdialysis, and a peridialytic blood pressure (defined as post-HD minus pre-HD SBP) between 0 and - 20 mmHg were analyzed. In Group 2, patients who required antihypertensive drugs for not meeting the aims of systolic blood pressure were included. The variables included clinical, demographic, mortality, description of the treatment, and routine laboratory tests in dialysis programs. The sample was nonprobabilistic. Survival analysis was performed for the study groups. The log-rank test (Mantel-Cox) was used for survival comparisons.</p><p><strong>Results: </strong>The study included 106 patients. Optimal blood pressure control without antihypertensive treatment was achieved in 52 patients (49.1%) (Group 1). In 54 patients (50.9%), antihypertensive agents were required (Group 2). There was more significant mortality in the group that received antihypertensives: 11 patients in group 1 (21.2%) versus 25 patients in group 2 (46.3%) (P = 0.005). Survival was more significant in group 1, with an HR of 2.2163 (1.125-4.158) (P = 0.0243).</p><p><strong>Conclusion: </strong>In hemodiafiltration and hemodialysis programs, blood pressure control with active ultrafiltration measures and without using antihypertensives is essential for survival in patients with CKD.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"30"},"PeriodicalIF":2.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999785","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":"Risk factors for the mortality of hemodialysis patients with COVID-19 in northern Hunan province, China.","authors":"Zhangxiu He, Zhong Peng, Ning Gao, Shuzhu Zhong, Fengyi Yu, Zixu Tang, Zihao Liao, Song Zhao, Gloria Umwiza, Ming Chen, Wei Long","doi":"10.1186/s12882-025-03946-2","DOIUrl":"https://doi.org/10.1186/s12882-025-03946-2","url":null,"abstract":"<p><strong>Purpose: </strong>Exploring the risk factors for mortality of hemodialysis patients undergoing COVID-19 and the changes in mortality before and after the opening of the epidemic in northern Hunan province, China.</p><p><strong>Methods: </strong>We analyzed 230 hemodialysis patients with COVID-19 in the Yiyang Central Hospital from November 01, 2022 to February 28, 2023. Demographic data, laboratory data and public diseases were collected. Cox regression analysis was used to identify risk factors and independent predictors of mortality. The receiver operating characteristic (ROC) curve was used to determine the diagnostic value of risk factors in hemodialysis COVID-19 patients.</p><p><strong>Results: </strong>The average duration of the disease was 12.53 days. The mortality rate in our cohort was 28.70%. Independent predictors of mortality in our cohort were: age (hazard ratio [HR] 1.09; 95% confidence interval [CI], 1.05-1.14; P < 0.001), elevated procalcitonin (PCT) levels (HR 1.02; 95%CI, 1.01-1.03; P < 0.001), and higher white blood cell-neutrophil ratio (NWR) (HR 1.04; 95%CI, 1.04-1.07; P = 0.004). Areas under the ROC curve (AUC) for age, NWR, PCT, age*NWR were 0.70 (95%CI: 0.62-0.77), 0.82 (95%CI: 0.75-0.90), 0.64 (95%CI: 0.55-0.73), and 0.89 (0.85,0.94).</p><p><strong>Conclusion: </strong>We discovered that old age, high levels of NWR and PCT might be predictors of mortality, reported the causes and prognostic predictors of mortality in hemodialysis populations with COVID-19 from northern Hunan, China.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"26"},"PeriodicalIF":2.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999949","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":"Pulse wave parameters as a predictor of the development of post-transplant diabetes mellitus after kidney transplantation.","authors":"Dominika Macakova, Josef Zadrazil, David Karasek, Veronika Kucerova, Katerina Langova, Lubica Cibickova","doi":"10.1186/s12882-024-03938-8","DOIUrl":"10.1186/s12882-024-03938-8","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplantation is the preferred treatment for patients with end-stage renal disease, significantly preserving kidney function and patient quality of life. However, post-transplant diabetes mellitus (PTDM) is a common complication, occurring in approximately one-third of renal transplant recipients. This study aims to evaluate the role of pulse wave parameters in predicting PTDM and to identify other pre-transplant risk factors.</p><p><strong>Methods: </strong>This prospective cohort study included 105 patients on the kidney transplant waiting list from 2017 to 2022. Exclusion criteria included any pre-existing diabetes mellitus. Patients underwent physical examinations, laboratory analyses, and pulse wave analysis before transplantation and one year post-transplant. PTDM diagnosis followed International Consensus Guidelines. Data were analyzed using Wilcox test, Bonferroni correction, May-Whitney U-test, and Fisher's exact test, with p < 0.05 considered statistically significant.</p><p><strong>Results: </strong>Post-transplant, 21% of patients were diagnosed with PTDM, increasing to 35% 3months post-transplant and 43% at one year post-transplant. Significant findings included: Pre-transplat risk factors for developing PTDM: Proteinuria (p = 0.037, OR = 3.942) and perioperative hyperglycemia (p = 0.003, OR = 4.219 at 3 months; p = 0.001, OR = 4.571 at 1 year). Pulse wave parameters for developing PTDM: Pre-transplant Aortic PP > 45 mmHg (AUC = 0.757) and PWV > 8.5 m/s (AUC = 0.730) were strong predictors of the development of PTDM after 3 months (p < 0.0001). Moreover, we found significant improvements in aortic pulse pressure (Aortic PP) and pulse wave velocity (PWV) post-transplant (p < 0.0001).</p><p><strong>Conclusion: </strong>Our study confirms that pulse wave parameters, such as Aortic PP and PWV, are significant predictors of PTDM in kidney transplant recipients (KTR). These findings support incorporating pulse wave analysis into routine pre-transplant evaluations to identify high-risk patients. Additionally, monitoring these parameters post-transplant may aid in early intervention and prevention of PTDM, ultimately improving patient outcomes.</p><p><strong>Trial registration: </strong>Ethical approval was obtained from the Ethics Committee of Medical faculty and University Hospital Olomouc (approval no. 94/15).</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"27"},"PeriodicalIF":2.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999948","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 versus late nephrology referral and patient outcomes in chronic kidney disease: an updated systematic review and meta-analysis.","authors":"Linan Cheng, Nan Hu, Di Song, Li Liu, Yuqing Chen","doi":"10.1186/s12882-025-03944-4","DOIUrl":"10.1186/s12882-025-03944-4","url":null,"abstract":"<p><strong>Background: </strong>Nephrology referral has been recognized as a modifiable factor influencing patient outcomes. The study aimed to compare clinical outcomes among patients referred early versus late to nephrologists.</p><p><strong>Methods: </strong>We searched online database from inception to June 1, 2022, to obtain all eligible literature reporting outcomes of patients referred early versus late to nephrologists. The early and late referral was defined by the time at which patients were referred to nephrologists before dialysis onset.</p><p><strong>Results: </strong>Seventy-two studies with over 630,000 patients met the inclusion criteria. A lower likelihood of all-cause mortality (HR = 0.67, 95% CI: 0.62-0.72) was achieved among patients referred early to nephrologists. The survival advantage of early referral was apparent in the first 6 months and extended to the 5th year after dialysis onset (6 months: HR = 0.52, 95% CI: 0.40-0.68; 5 years: HR = 0.67, 95% CI: 0.60-0.74). The early referral was associated with shorter durations of initial hospitalization, a higher rate of kidney transplantation (RR = 1.41, 95% CI: 1.12-1.78), a lower likelihood of emergency start (RR = 0.39, 95% CI: 0.28-0.54), a higher likelihood of permanent access creation (RR = 3.34, 95% CI: 2.43-4.59), increased initial use of permanent access (RR = 2.60, 95% CI: 2.18-3.11), and reduced initial catheter use (RR = 0.43, 95% CI: 0.32-0.58).</p><p><strong>Conclusions: </strong>Our study showed a lower risk of mortality, shorter lengths of initial hospitalization, and better preparations for renal replacement therapy among patients referred early to nephrologists. Early nephrology care should be promoted to improve the management of advanced chronic kidney disease.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"25"},"PeriodicalIF":2.2,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999990","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":"Clinicopathological characteristics and predictors of renal outcomes in diffuse crescentic glomerulonephritis : a retrospective single-center study from Western China.","authors":"Shan Wen, Shasha Chen, Yingying Lin, Guisen Li, Ping Zhang, Wei Wang","doi":"10.1186/s12882-024-03923-1","DOIUrl":"10.1186/s12882-024-03923-1","url":null,"abstract":"<p><strong>Background: </strong>The factors influencing diffuse crescentic glomerulonephritis renal survival and prognosis remain uncertain. Additionally, there's no literature on the clinical outcomes of IgA nephropathy, lupus nephritis, and IgA vasculitis nephritis in type II patients.</p><p><strong>Methods: </strong>This study retrospectively examined 107 patients diagnosed with diffuse crescentic glomerulonephritis through biopsy. Analytical methods included Cox regression models and Kaplan-Meier survival analysis to assess the data.</p><p><strong>Results: </strong>Among the 107 enrolled patients, 12 patients had Type I diffuse crescentic glomerulonephritis, 70 patients had Type II, and 25 patients had Type III. The respective 5-year kidney survival rates were 0%, 57.5%, and 18.6% for type I, type II, and type III. Furthermore, among Type II patients, IgA nephropathy emerged as the most prevalent condition. The cumulative 5-year kidney survival rates were 50% for patients with IgA nephropathy, 64% for lupus nephritis, and 70% for Henoch-Schönlein purpura nephritis. A significant association between the risk of ESKD development and several factors was revealed by a multivariate Cox regression analysis: estimated glomerular filtration rate (P = 0.004), initial kidney replacement therapy (KRT) at presentation (P = 0.002), global glomerulosclerosis (P<0.001).</p><p><strong>Conclusions: </strong>Type II diffuse crescentic glomerulonephritis was the most prevalent type in DCGN, and favors better renal prognosis than type I and III DCGN, in which IgA nephropathy was the most common entity of Type II DCGN. Additionally, estimated glomerular filtration rate, initial KRT at presentation and global glomerulosclerosis were identified as predictors of renal outcomes in diffuse crescentic glomerulonephritis.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"24"},"PeriodicalIF":2.2,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982799","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}