Kidney and Dialysis doi: 10.3390/kidneydial6030062

Authors: Bharathi Naik Shankar Prasad Nagaraju Anuja Damani Arun Ghoshal Pankaj Singhai Naveen Salins Ravindra Prabhu Attur Swathi Nayak Ammunje Ajith M. Nayak Mohan V. Bhojaraja Srinivas Vinayak Shenoy Shilna Muttickal Swaminathan Dharshan Rangaswamy Indu Ramachandra Rao

Background: Patients with end-stage kidney disease (ESKD) often experience significant symptom burden and reduced quality of life (QoL). This study compared these outcomes between hemodialysis (HD) and non-dialysis (ND) ESKD patients in India. Methods: A six-month cross-sectional study was conducted among 247 patients with ESKD aged ≥ 18 years, following Institutional Ethics Committee approval (IEC-214/2021). Symptom burden and QoL were assessed using the Edmonton Symptom Assessment System–Revised: Renal and EuroQol 5-Dimension 5-Level instruments. Results: HD patients reported a higher symptom burden than ND patients (81.3% vs. 65.8%), with fatigue being the most common symptom. They also had greater mobility impairment (63% vs. 45%) and lower EQ-5D-5L utility scores (0.69 ± 0.32 vs. 0.79 ± 0.27), indicating poorer QoL. Older age and lower education were associated with higher symptom burden, while poorer QoL was associated with older age, widowhood, lower education, and longer dialysis vintage (p < 0.05). Symptom burden was moderately correlated with poorer QoL (r = 0.60, p < 0.01). Conclusions: HD patients experience a greater symptom burden and poorer QoL than ND-ESKD patients. Routine symptom assessment and targeted symptom management may improve patient-centered outcomes.

Kidney and Dialysis doi: 10.3390/kidneydial6030061

Authors: Tan Huynh Ngoc Mai Linh Thi Thao Nguyen Dat Hoang Phan Tam Vo

Background: Endothelin-1 (ET-1) is a potent vasoconstrictor implicated in multiple complications of end-stage renal disease. This study evaluated the predictive value of baseline plasma ET-1 for 18-month all-cause mortality in Vietnamese hemodialysis patients. Methods: A prospective cohort study enrolled 222 patients on maintenance hemodialysis. Plasma ET-1 concentrations were quantified using an enzyme-linked immunosorbent assay (ELISA). The primary endpoint was 18-month all-cause mortality. Predictive accuracy was evaluated using receiver operating characteristic (ROC) curves, Kaplan–Meier survival analysis, and Cox proportional hazards regression models. Results: During the 18-month follow-up, 57 patients (25.68%) died. Non-survivors exhibited significantly higher median ET-1 levels compared to survivors (131.08 vs. 46.69 pg/mL, p < 0.001). The optimal ET-1 cutoff for predicting mortality was 85.06 pg/mL (area under the curve [AUC] = 0.875). Kaplan–Meier analysis demonstrated significantly worse survival in patients with ET-1 > 85.06 pg/mL (log-rank p < 0.001). In a multivariable Cox regression model adjusted for age, apparent treatment-resistant hypertension (aTRH), diabetes mellitus, and heart failure using a forward stepwise selection method, log2-transformed ET-1 remained a significant and independent predictor of all-cause mortality (hazard ratio [HR], 2.06; 95% confidence interval [CI], 1.52–2.79; p < 0.001). Conclusions: Baseline plasma ET-1 was independently associated with 18-month all-cause mortality in this single-center cohort of Vietnamese patients receiving maintenance hemodialysis. External validation is required before ET-1 can be recommended for routine clinical risk stratification.

Kidney and Dialysis doi: 10.3390/kidneydial6030060

Authors: Keiji Hirai Masako Shimotashiro Ryoko Sasaki Junki Morino Yuko Mutsuyoshi Haruhisa Miyazawa Kiyonori Ito Takahiro Masuda Susumu Ookawara Yoshiyuki Morishita

Background: We evaluated the anti-SARS-CoV-2 spike antibody response following seven doses of the BNT162b2 messenger RNA COVID-19 vaccine in patients undergoing hemodialysis and investigated factors associated with antibody levels after the fifth, sixth, and seventh doses. Methods: Forty patients were recruited in the analysis of this single-center, prospective, longitudinal study. Changes in anti-SARS-CoV-2 spike antibody levels between the second and seventh doses were evaluated. Factors independently associated with the antibody levels after the fifth, sixth, and seventh doses were determined by multiple linear regression analyses. Results: The antibody level was significantly higher 4 weeks after the third dose than 4 weeks after the second dose (17,000 [interquartile range (IQR), 9916–30,500] vs. 2372 [IQR, 896–4206] AU/mL, p < 0.001). The level was also significantly higher 4 weeks after the fourth dose than 4 weeks after the third dose (27,000 [IQR, 10,453–46,500] vs. 17,000 [IQR, 9916–30,500] AU/mL, p < 0.05). However, the levels 4 weeks after the fifth, sixth, and seventh doses were not significantly different from the level 4 weeks after the fourth dose. The antibody level 1 week before vaccination was correlated with the antibody level 4 weeks after vaccination at the fifth dose (standard coefficient [β] = 0.736, p < 0.001), sixth dose (β = 0.601, p < 0.001), and seventh dose (β = 0.717, p < 0.001). Conclusions: The antibody level increased between the second and fourth doses and then plateaued through the seventh doses in hemodialysis patients. The pre-vaccination antibody level was associated with the post-vaccination antibody level at the fifth, sixth, and seventh doses in this population.

Kidney and Dialysis doi: 10.3390/kidneydial6030059

Authors: Dung Nguyen Thi Thuy Tuyen Nguyen Van Hanh Bui My Kien Truong Quy Ha Nguyen Thi Thu Kien Nguyen Trung Thang Le Viet

High cardio-ankle vascular index (CAVI) and elevated plasma homocysteine are non-traditional cardiovascular biomarkers associated with adverse outcomes in chronic kidney disease. This study evaluated the 3-year all-cause mortality rate and the prognostic value of CAVI and plasma homocysteine in patients with end-stage kidney disease (ESKD) initiating maintenance hemodialysis (MHD). A prospective longitudinal study was conducted in 178 patients with ESKD who initiated MHD at Duc Giang General Hospital, Hanoi, Vietnam, between August 2020 and August 2021. Plasma homocysteine was measured using a chemiluminescent assay, and CAVI was assessed before hemodialysis. Patients were followed for 3 years until August 2024. During follow-up, 42 patients died, yielding an all-cause mortality rate of 23.6%. Multivariable Cox regression analysis identified low HDL-C, elevated hs-CRP, elevated plasma homocysteine, and higher CAVI as independent factors associated with all-cause mortality (all p ≤ 0.001). Receiver operating characteristic analysis showed good discriminatory ability for predicting 3-year mortality, with an area under the curve (AUC) of 0.905 (p < 0.001; cutoff, 9.45; sensitivity, 83.3%; specificity, 84.6%) for CAVI and 0.865 (p < 0.001; cutoff, 32.23 μmol/L; sensitivity, 76.2%; specificity, 84.6%) for plasma homocysteine. Kaplan–Meier analysis demonstrated significantly lower survival in patients with higher CAVI and plasma homocysteine levels (log-rank, p < 0.001). In conclusion, higher CAVI and elevated plasma homocysteine were independently associated with increased all-cause mortality and showed good discriminatory ability for risk stratification during the first 3 years of MHD.

Kidney and Dialysis doi: 10.3390/kidneydial6030058

Authors: Khaled Abdulwahab Amer Mona Alshahrani Aeyd Jobran Alhashim Mofareh Ahmed Asiri Mousa Mohammed Alshehri

Background: Chloride is the principal extracellular anion but is seldom used in risk assessment in kidney disease, where attention centres on sodium and potassium. Individual cohorts have linked abnormal serum chloride to mortality, but the evidence has not been synthesised. Methods: We searched PubMed, OpenAlex, the Web of Science Core Collection and Embase (to 13 July 2026) for longitudinal observational studies reporting a multivariable-adjusted association between serum chloride and all-cause (primary) or cardiovascular (secondary) mortality in adults with chronic kidney disease (CKD) or on maintenance dialysis. Adjusted hazard ratios (HRs) were pooled using DerSimonian–Laird random-effects models; studies on incompatible continuous scales were summarised narratively. Risk of bias was assessed using QUIPS, the Newcastle–Ottawa Scale, and GRADE. Results: Seven cohort studies (10,692 participants) were included. In the primary pool of three categorical studies, hypochloraemia was associated with higher all-cause mortality (pooled-adjusted HR 2.46; 95% CI 1.79–3.38; τ2 = 0; I2 = 0%). Two haemodialysis cohorts modelling chloride continuously reported associations in the same direction but on different scales and were not pooled; one younger peritoneal-dialysis cohort showed the opposite direction. Certainty was low to very low. Conclusions: Serum chloride may carry prognostic information, but its direction appears context- and modality-dependent, causality remains unproven, and it is not yet a validated risk-stratification marker.

Kidney and Dialysis doi: 10.3390/kidneydial6030057

Authors: Ibtisam Al Saidi Joshua Kanaabi Muliira Eilean Rathinasamy Lazarus Omar Alzaabi

Background: Patients on Peritoneal Dialysis (PD) experience substantial dialysis-related symptoms and medication non-adherence that negatively impact clinical outcomes, yet these remain understudied in Oman and other Middle East countries. Objectives: To determine the prevalence of dialysis-related symptoms and assess medication adherence among Omani adult patients on PD. Methods: A descriptive cross-sectional correlational study was conducted among 185 Omani adults receiving PD, recruited using stratified random sampling from government hospitals across Oman. Data were collected using a self-administered questionnaire comprising the researcher-developed Peritoneal Dialysis Symptoms and Life Impact Scale (PD-SLIS; Cronbach’s α = 0.97) and the Arabic version of the Adherence to Refills and Medications Scale (ARMS; Cronbach’s α = 0.71). Data were analyzed using descriptive statistics, chi-square tests, and multiple logistic regression. Results: The participants’ mean age was 51.54 ± 14.92 years, and 50.3% were female. The mean total symptom burden score was 82.56 ± 54.60. The most prevalent symptoms were limitations in general activities (85.9%), mood changes (85.9%), lack of energy (82.7%), and weakness (81%). All the 34 assessed symptoms were reported by ≥47% of the participants. Most participants (66.5%) reported low medication adherence (mean ARMS score = 19.73 ± 5.42). Regression analysis identified age (OR = 1.04, p = 0.02), high school education (OR = 4.68, p < 0.01), and daily number of medications (OR = 0.89, p = 0.04) as significant independent predictors of medication adherence. Conclusions: Omani patients on PD experience a pervasive symptom burden alongside predominantly low medication adherence. Routine symptom screening using the PD-SLIS, polypharmacy reduction strategies, and adherence interventions are recommended as standard components of PD clinical practice in Oman and other settings with similar contexts.

Kidney and Dialysis doi: 10.3390/kidneydial6030056

Authors: Hao Thi Minh Dinh Ngoc That Ton Tam Vo

Background: Cardiovascular complications majorly drive mortality across the spectrum of chronic kidney disease (CKD). This study evaluated serum Galectin-3 levels across chronic kidney disease (CKD) stages and their association with microinflammation and cardiac dysfunction in MHD patients. Methods: This cross-sectional study included 206 patients (CKD stages 3–5 non-dialysis [ND], MHD, and post-kidney transplantation) and 70 healthy controls. Serum Galectin-3 was measured using a Chemiluminescent Microparticle Immunoassay. Results: Median Galectin-3 levels increased progressively from stage 3 (29.50 ng/mL) to stage 4 (39.85 ng/mL), reached the highest levels in stage 5ND (52.70 ng/mL) and MHD (65.15 ng/mL), but plunged post-transplantation (19.45 ng/mL). In the MHD group, patients with high Galectin-3 (>65.15 ng/mL) exhibited significantly higher CRP levels compared to those with low Galectin-3 (2.39 vs. 1.22 mg/L, p = 0.013). Galectin-3 correlated positively with troponin T (r = 0.266, p = 0.037). ROC analysis showed that Galectin-3 discriminated left ventricular systolic dysfunction (EF < 50%) with an AUC of 0.557 (95% CI: 0.401–0.714), yielding an optimal cut-off of ≥52.85 ng/mL (sensitivity: 86.7%, specificity: 31.9%). Conclusions: Serum Galectin-3 is elevated in MHD patients and correlates with systemic microinflammation (CRP), but its association with myocardial injury lost statistical significance after multivariable adjustment (p = 0.057). Furthermore, an exploratory cut-off of ≥52.85 ng/mL did not demonstrate statistically significant discrimination for left ventricular systolic dysfunction (p = 0.506), highlighting the complex, multifactorial nature of uremic cardiomyopathy.

Kidney and Dialysis doi: 10.3390/kidneydial6030055

Authors: Olivia B. Friedman Jairo N. Fuertes Michael T. Moore Sofia Rubinstein Theudia Chambers

This study presents a slide-based video cognitive behavioral therapy (CBT)-informed psychoeducational intervention for chronic kidney disease (CKD) and end-stage kidney disease (ESKD) patients. The intervention addresses the lack of mental healthcare interventions for CKD patients, who experience disproportionate mental health challenges. The intervention is available in English and Spanish. The intervention includes four modules on the following: 1. depression; 2. anxiety; 3. locus of control and social support; and 4. treatment adherence, each with exercises. The intervention was tested with a sample of 45 CKD and ESKD patients, including individuals with CKD not receiving hemodialysis (HD) and individuals with ESKD receiving HD. Results showed a statistically significant within-participant reduction in PHQ-9 scores from pre- to post-intervention. The intervention did not yield significant pre- to post- changes in patients’ anxiety or locus of control. Associations between treatment adherence and depression, anxiety, locus of control, social support, and resilient coping were not statistically significant after applying the Bonferroni correction. Participant feedback was positive; they identified breathing exercises as the most helpful component, followed by medication adherence strategies, and referenced family members as supports. These preliminary results show that this CBT-informed intervention may have the potential to address depression in CKD/ESKD patients.

Kidney and Dialysis doi: 10.3390/kidneydial6030054

Authors: Esteban Zavaleta-Monestel Jeaustin Mora-Jiménez Kevin Cruz-Mora Sebastián Arguedas-Chacón Luis Guillermo Herrera-Jiménez José Andrés Castro-Gamboa José Miguel Chaverri-Fernández

Background: Contrast media are essential tools in diagnostic and interventional imaging, but their relationship with acute kidney injury remains clinically relevant and conceptually debated. This narrative review aimed to synthesize current evidence on contrast media-associated nephrotoxicity, including terminology, epidemiology, pathophysiology, risk stratification, prevention, pharmacotherapeutic management, and clinical decision-making. Methods: A structured literature search was conducted in major biomedical databases and complemented by international guidelines and consensus statements addressing contrast-associated and contrast-induced acute kidney injury in adults exposed to intravascular contrast media. Discussion: Contemporary evidence emphasizes the distinction between contrast-associated acute kidney injury, which reflects a temporal association after exposure, and contrast-induced acute kidney injury, which implies causality. The renal risk directly attributable to modern intravenous iodinated contrast media appears to have been historically overestimated, although clinically relevant risk persists in vulnerable patients. Proposed mechanisms include renal vasoconstriction, medullary hypoxia, oxidative stress, mitochondrial dysfunction, tubular epithelial injury, endothelial dysfunction, and inflammatory or apoptotic pathways. Preventive strategies should be individualized, with isotonic saline remaining the main intervention when indicated, whereas routine pharmacologic prophylaxis is not supported by consistent clinically meaningful benefit. Conclusions: Renal safety in contrast-enhanced imaging requires a balanced approach that minimizes avoidable kidney injury in high-risk patients without unnecessarily delaying clinically indicated diagnostic or therapeutic procedures.

Kidney and Dialysis doi: 10.3390/kidneydial6030052

Authors: Karol Graňák Matej Vnučák Patrícia Kleinová Tímea Blichová Andrej Kollár Katarína Ševčíková Margaréta Graňák Pytliaková Ivana Dedinská

Background: Glycemic variability (GV) may play an important role in metabolic outcomes after kidney transplantation (KT). This study aimed to evaluate the association between early post-transplant GV, assessed by continuous glucose monitoring (CGM), and the subsequent development of post-transplant dysglycemia. Methods: This prospective exploratory pilot study included adult recipients of primary deceased-donor KT at Martin University Hospital, Slovakia. The Dexcom G6 CGM system was applied immediately before KT and continuously measured interstitial glucose for seven days after KT. Demographic, clinical, and biochemical data were collected on day 0, and 7, and at months 3, 12. Results: Twenty patients completed the 12-month follow-up. PTDM/prediabetes developed in 10 (50%) and had higher HbA1c on day 7 (p = 0.038) and lower postprandial insulin (p = 0.042). At 3 and 12 months, HbA1c (p = 0.006), fasting insulin (p = 0.0219), and HOMA-IR (p = 0.006) were significantly elevated in this group. CGM demonstrated higher mean glucose (p = 0.021), SD (p = 0.001), and estimated HbA1c (p = 0.017), with longer time above range (p = 0.042) and shorter time in range (p = 0.037). In exploratory regression analyses, CV ≥ 36% (aOR 7.31, p = 0.049) and TAR (aOR 1.35, p = 0.045) were associated with subsequent PTDM/prediabetes. Conclusions: In this prospective exploratory pilot study, higher early postoperative GV was associated with subsequent post-transplant dysglycemia. These findings suggest that CGM-derived metrics may help identify patients at higher metabolic risk after KT; however, given the small sample size and exploratory design, the results should be interpreted as hypothesis-generating.

Kidney and Dialysis doi: 10.3390/kidneydial6030053

Authors: Iryna Dudar Iurii Rudyk Patrick Biggar Kateryna Zupanets

Anemia management in chronic kidney disease patients is a significant challenge for modern healthcare professionals. Anemia in chronic kidney disease patients has multiple causes, which include erythropoietin deficiency, abnormal iron metabolism, resistance to erythropoietin signaling, bone marrow suppression, blood loss, inflammation, nutrition deficiencies, and oxidative stress. Vadadustat, a stabilizer of hypoxia-inducible factor (HIF), is indicated for the treatment of symptomatic anemia associated with chronic kidney disease (CKD) in adults on chronic maintenance dialysis. Evidence-based pharmaceutical care services are of great importance for chronic kidney disease patients because they provide safe and cost-effective care for patients. In the present article, we outline the most important pharmaceutical aspects that may affect the efficacy and safety of drug therapy with vadadustat and other HIF stabilizers. We conclude that evidence-based pharmaceutical care is one of the criteria that promotes management of vadadustat therapeutic efficacy and safety. Such an approach will contribute to improving patient adherence to treatment and, consequently, quality of life. Special attention is paid to structure-derived side effects of widely used HIF stabilizers, including their advantages and disadvantages. Based on all available safety and efficacy data for vadadustat, the overall risk–benefit profile remains positive for the approved indications for use.

Kidney and Dialysis doi: 10.3390/kidneydial6030051

Authors: Carlos Rebolledo-Maldonado Juan Solano-Ropero Elber Osorio-Rodríguez Aleyda Parra-Castillo Carlos Beltran-Sánchez Neil Martínez-Fontalvo Diego González-Betancur Dairo Rodelo-Barrios Manuel Cueto-Chaparro José Correa-Guerrero Alberto Polo-Barranco Carmelo Dueñas-Castell

Severe metabolic acidosis is a frequent finding in the intensive care unit (ICU) and a critical marker of clinical severity and organ dysfunction, closely linked to acute kidney injury (AKI) due to shared physiological mechanisms and the loss of the kidney’s ability to maintain acid-base homeostasis. Therefore, it represents the biochemical expression of heterogeneous pathophysiological mechanisms related to acid-base balance. These include tissue hypoperfusion, sepsis, mitochondrial dysfunction, accumulation of unmeasured anions, bicarbonate loss, and reduced renal excretion of the acid load. Its presence is associated with increased mortality, greater vasopressor and mechanical ventilation requirements, prolonged ICU stay, and a higher likelihood of renal replacement therapy (RRT). However, pH correction alone does not guarantee clinical improvement. Therefore, contemporary management prioritizes the etiology, severity of the acidemia, and hemodynamic status. In this context, sodium bicarbonate plays a limited and selective role, particularly in severe acidemia with advanced AKI or hyperkalemia, or as temporary supportive therapy while the underlying cause is corrected or extracorporeal support is arranged. Similarly, RRT should be reserved for refractory cases and should not be initiated based solely on isolated pH thresholds. This review analyzes the definition, epidemiology, clinical implications, pathophysiology, and therapeutic strategies for severe metabolic acidosis in critically ill patients, with emphasis on its interaction with AKI, the rational use of bicarbonate, and the timing of RRT initiation.

Kidney and Dialysis doi: 10.3390/kidneydial6030050

Authors: Dwi Oktari Erfanti Tetty Yuniati Fiva Aprilia Kadi Aris Primadi Ahmedz Widiasta Dwi Prasetyo Harry Galuh Nugraha Johanes Edy Siswanto

Background: Renal artery resistive index (RI) may reflect renal–vascular adaptation in preterm neonates, but its ability to distinguish early hypertension from acute kidney injury (AKI) remains uncertain. Methods: This prospective cohort study enrolled preterm neonates born at 28–34 weeks’ gestation at Dr. Hasan Sadikin Hospital, Indonesia. Renal Doppler ultrasonography was performed at 72 h of life to measure the RI of the right and left renal arteries. Blood pressure was assessed during the first postnatal week using repeated non-invasive oscillometric measurements. AKI was defined according to neonatal Kidney Disease: Improving Global Outcomes criteria. Associations between RI, early-onset hypertension, and AKI were evaluated using bivariate analyses, receiver operating characteristic curves, and exploratory adjusted logistic regression. Results: Of 113 eligible infants, 77 completed follow-up evaluation. Higher RI values were associated with early-onset hypertension in univariable analyses for both the right (p = 0.010) and left (p = 0.038) RI. RI thresholds > 0.94 for the right renal artery and >0.87 for the left renal artery were associated with increased risk of hypertension. RI values did not differ significantly between infants with and without AKI. Exploratory adjusted analyses showed attenuation of side-specific associations, whereas the higher bilateral RI value suggested a modest hypertension-related signal. Conclusions: In this cohort of clinically stable surviving preterm neonates, renal artery RI showed a clearer association with early-onset hypertension than with AKI classified using the study’s operational KDIGO approach. RI may provide adjunctive physiological information regarding vascular impedance and early cardiovascular–renal adaptation, but it should not be interpreted as a specific or stand-alone biomarker of hypertension or kidney injury. These findings are hypothesis-generating and require validation in larger multicenter cohorts using serial renal and hemodynamic assessments.

Kidney and Dialysis doi: 10.3390/kidneydial6030049

Authors: Mahdi Tarabeih Jamal Qaddumi Osama Sawalmeh Sajeda Hamadi

Peritoneal ultrafiltration failure is a major complication of peritoneal dialysis and a common cause of technique failure often leading to hemodialysis. Chronic exposure to glucose-based dialysate contributes to inflammation, fibrosis, and peritoneal membrane dysfunction. This study evaluated the effects of dapagliflozin on peritoneal membrane function in patients with ultrafiltration failure undergoing continuous ambulatory peritoneal dialysis. In our pre–post observational study, 32 patients with high/high–average peritoneal transport status and ultrafiltration failure received dapagliflozin 10 mg daily for six months. Peritoneal equilibration tests using a 4.25% dextrose solution were performed during early peritoneal dialysis, at ultrafiltration failure, and after treatment. Ultrafiltration volume, dialysate-to-plasma creatinine ratio, dialysate glucose ratio, sodium dip, and clinical/biochemical parameters were assessed. Dapagliflozin treatment was found to be associated with higher ultrafiltration volume (480 mL vs. 90 mL at ultrafiltration failure, p < 0.001), preservation of the intraperitoneal glucose gradient, changes in the dialysate-to-plasma creatinine ratio, and altered sodium dip parameters. Favorable changes were also observed in blood pressure, body mass index, inflammatory markers, hemoglobin, albumin, sodium, bicarbonate, and glycemic indices. No serious adverse events were reported. These findings suggest that dapagliflozin may improve ultrafiltration efficiency and peritoneal membrane function in peritoneal dialysis patients with ultrafiltration failure. Further randomized controlled trials are warranted.

Kidney and Dialysis doi: 10.3390/kidneydial6030048

Authors: William A. Vasquez Espinosa Seolhyun Lee Josef K. Suba Lindsey S. Keo Timothy W. Meyer Tammy L. Sirich

Background: Ergothioneine is a diet-derived antioxidant with a specific membrane transporter that uptakes it into tissues susceptible to oxidative stress. We previously found that efficient dialytic clearance leads to marked ergothioneine depletion in patients on hemodialysis. Continuous renal replacement therapy (CRRT) provides higher time-averaged clearances of small solutes than hemodialysis. We therefore examined whether ergothioneine is depleted in patients receiving CRRT. Methods: We first compared erythrocyte and plasma ergothioneine levels in 19 critically ill subjects maintained on CRRT for ≥2 days (CRRT), 18 critically ill subjects without kidney impairment (CI), and 15 healthy subjects (control). We then examined the degree to which initiation of CRRT reduced ergothioneine levels in a separate group of 11 subjects after ≥2 days on CRRT and measured ergothioneine in the effluent fluid to calculate its CRRT clearance. Results: Compared to controls, erythrocyte and plasma ergothioneine levels were depleted in both critically ill subjects maintained on CRRT for 20 ± 26 days and critically ill subjects not on CRRT (erythrocyte: CRRT 226 ± 121 μM, CI 208 ± 132 μM, control 593 ± 568 μM; plasma: CRRT 0.52 ± 0.37 μM, CI 0.86 ± 0.83 μM, control 2.3 ± 1.7 μM). Initiation of CRRT in a separate group of 11 subjects significantly reduced the plasma level but not the erythrocyte level of ergothioneine after 3.4 ± 1.0 days. CRRT provided similar efficient clearances of ergothioneine, urea, and creatinine (31 ± 8, 38 ± 8, and 36 ± 10 mL/min). Conclusions: Ergothioneine is significantly depleted in critically illness, and prolonged CRRT may worsen the depletion. Our findings motivate further investigation of the impact of ergothioneine depletion in critical illness.

Kidney and Dialysis doi: 10.3390/kidneydial6030047

Authors: Eilean R. Lazarus Hana Al Balushi Maryam Al-Riyami Wafa Al Aadi Qaterunada Al Hinai Houda Al Bahluli Muna Al Hinai Zainab Al Kindi Nasser Al-Salmi

End-stage kidney disease (ESKD) is a growing public health concern in Oman, with an increasing number of adults requiring hemodialysis and facing complex dietary restrictions. Adequate nutrition knowledge and nutrition literacy are essential for effective dietary self-management, yet their relationship with dietary adherence in the Omani hemodialysis population remains underexplored. To determine the level of dialysis-specific nutrition literacy among Omani adults with end-stage kidney disease undergoing hemodialysis and to identify socio-demographic and clinical factors that predict acceptable nutrition literacy in this population. A cross-sectional study was conducted among 140 adults with ESKD receiving hemodialysis in Oman. Data were collected using a structured, self-administered questionnaire comprising socio-demographic and clinical items, the Dialysis-Specific Nutrition Literacy Scale (DSNLS), the Dialysis-Related Diet Knowledge Questionnaire (DDKQ), and adherence/health-belief subscales (perceived benefits, barriers, seriousness, susceptibility, and self-efficacy). Descriptive statistics summarized sample characteristics and scale scores. Correlation analyses assessed relationships between nutrition literacy, diet knowledge, and adherence-related perceptions. Multiple logistic regression identified independent predictors of acceptable nutrition literacy. Participants had a mean age of 48.19 years and a mean dialysis duration of 5.46 years. Overall, 60.7% had acceptable dialysis-specific nutrition literacy and 39.3% had limited literacy. Dialysis-related diet knowledge was low in 10.7%, moderate in 46.4%, and high in 42.9% of participants. Perceived benefits of dietary adherence were high, whereas perceived barriers, seriousness, and susceptibility were moderate and self-efficacy was relatively low. Nutrition literacy was positively correlated with perceived benefits, seriousness, susceptibility, and self-efficacy, while diet knowledge showed weaker associations with these beliefs. In the logistic regression model, living in the city (OR = 0.17, p = 0.01) and having diabetes mellitus as a comorbidity (OR = 0.17, p = 0.01) were associated with lower odds of acceptable nutrition literacy, whereas higher hemoglobin levels (OR = 1.51, p = 0.04) and self-rated “very good” overall health (OR = 5.80, p = 0.03) were associated with higher odds. Most Omani adults on hemodialysis demonstrated acceptable nutrition literacy and at least moderate renal-diet knowledge, but a substantial subgroup had limited literacy and low self-efficacy for dietary adherence. Nutrition literacy was more strongly linked to adherence-related beliefs than factual knowledge alone and was influenced by place of residence, comorbid diabetes, hemoglobin level, and perceived health. These findings highlight the need for culturally tailored, literacy-sensitive nutrition education in Omani dialysis units, with particular attention to urban patients and those with diabetes, to strengthen self-efficacy, address perceived barriers, and ultimately improve dietary adherence and clinical outcomes.

Kidney and Dialysis doi: 10.3390/kidneydial6030046

Authors: Reina Suetsugu-Ishizawa Megumi Matsumoto Hirofumi Sakuma Motoki Matsuki Mitsuru Yanai Yayoi Ogawa Naoki Nakagawa

Membranous nephropathy (MN) is a leading cause of nephrotic syndrome (NS). The remission rate of MN remains limited, and effective strategies for refractory MN are not established. We present the case of a 49-year-old Japanese woman with severe NS caused by MN. Kidney biopsy revealed glomerular basement membrane thickening with granular deposition of immunoglobulin G (IgG) and complement component 3. IgG subclass analysis showed predominant IgG1 deposition, with weak IgG2 and IgG3 deposition. Phospholipase A2 receptor (PLA2R) deposition was equivocal in the first kidney biopsy and negative in the second. Serum anti-PLA2R antibody was not detected. Electron microscopy revealed subepithelial, subendothelial, and mesangial electron-dense deposits. Detailed screening revealed no significant abnormalities other than appendiceal findings, suggesting secondary MN associated with appendiceal infection. Although combined therapy with prednisolone, cyclosporine, rituximab, and low-density lipoprotein apheresis was administered during the first 6 months, remission of MN was not achieved. During dialysis, initiated because of kidney failure, long-term multidisciplinary management, including control of appendiceal infection and inflammation and initiation of angiotensin II receptor blocker therapy, ultimately led to remission of MN and discontinuation of dialysis. Overall, even refractory MN requiring dialysis may have a reversible clinical course with careful conservative management and long-term follow-up.

Kidney and Dialysis doi: 10.3390/kidneydial6030045

Authors: Naomi Yoshida Hitomi Matsuda Akihiko Araki Naoki Maki Sayuri Osanai Thomas Mayers

Life expectancy among older adults undergoing hemodialysis (HD) has increased, yet more than 70% experience physical frailty or pre-frailty before progressing to severe disability. Declines in social functioning in this population have also been associated with higher mortality risk and poorer quality of life. Despite this, relatively few studies have explored methods for evaluating social relationships and frailty among older adults receiving HD. This scoping review aimed to identify how previous studies have evaluated social relationships in this population, examine factors associated with frailty, and clarify potential research gaps. Inclusion and exclusion criteria were defined according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Participants were community-dwelling adults aged 60 years and older receiving HD. Using predefined keywords and search terms, literature searches were conducted across Cochrane Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsycINFO, and gray literature sources (e.g., WorldCat). This review was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry database (UMIN000055770). Twelve studies met the inclusion criteria. Frailty was assessed using physical (7 studies), multidimensional (3 studies), cognitive (1 study), and social measures (1 study). Nineteen social relationship factors were identified and categorized into three dimensions: social attributes, social activities, and social needs. However, none of the studies evaluated the appropriateness or validity of these elements for assessing social relationships among older HD patients. The findings indicate a need to validate assessment tools that integrate physical frailty and social relationship dimensions in older adults undergoing HD, which may allow earlier identification of individuals at risk of adverse outcomes.

Kidney and Dialysis doi: 10.3390/kidneydial6030044

Authors: Jihyun Yang Sang Kyung Jo

Growing recognition of the gut–kidney axis has revealed that gut dysbiosis and altered mucosal immunity are intimately intertwined with acute kidney injury (AKI). Gut changes following AKI, including dysbiosis and associated altered metabolites, barrier disruption, and maladaptive immune responses, affect post-AKI outcomes in a bidirectional manner. Therefore, the gut is increasingly recognized as a previously underappreciated modifier of AKI, and recent research is beginning to dissect the causal relationships between microbial perturbations and AKI, as well as the mechanisms underlying these complex interactions. However, relevant data remain limited, underscoring the need for further mechanistic and translational studies to fully elucidate key pathways for the development of novel, gut-targeted therapeutics. In this review, we summarize the mechanisms by which gut dysbiosis contributes to AKI outcomes and discuss gut-based therapeutic options based on experimental and clinical studies as well as future perspectives.

Kidney and Dialysis doi: 10.3390/kidneydial6020043

Authors: Teodor Cãluși Alexandru Iordache Lucas-Gabriel Discălicău Oana Moldoveanu Bogdan Sorohan

Kidney transplantation is the treatment of choice for end-stage renal disease, although delayed graft function remains a frequent early complication with important clinical implications. Because early graft recovery depends on adequate perfusion, careful perioperative volume assessment and hemodynamic optimization are essential. Conventional markers such as interdialytic weight gain and estimated dry weight provide only indirect information on intravascular volume and may lead to pre-transplant misclassification of volume status. Complementary tools, including bioimpedance, natriuretic peptides, and congestion-focused ultrasound, may improve characterization of fluid distribution and hemodynamic stress, but none reliably define effective graft perfusion. Pressure-based parameters remain central to perioperative management; however, mean arterial pressure reflects systemic perfusion pressure and may be preserved despite reduced renal blood flow. Central venous pressure is an imprecise surrogate of intravascular volume and fluid responsiveness, with inconsistent associations with clinical outcomes across studies. In this context, flow-guided strategies based on dynamic indices of fluid responsiveness provide a more direct assessment of circulatory adequacy and have been associated, in selected studies, with improved early graft outcomes. Overall, the evidence supports a multimodal approach integrating volume assessment tools with pressure- and flow-oriented monitoring to optimize graft perfusion and early transplant outcomes.

Kidney and Dialysis doi: 10.3390/kidneydial6020042

Authors: Maria Divani Katerina Katsanaki Maria Tziastoudi Panagiota Makri Christina Poulianiti Evangelos Lykotsetas Andriani Balatsouka Ioannis Stefanidis Theodoros Eleftheriadis

Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is released in response to increased cardiac wall stress and is used as a biomarker for volume overload and heart failure (HF). It is also elevated in atrial fibrillation (AF) and inflammation. However, in hemodialysis (HD) patients, its interpretation is complicated by reduced renal clearance, large fluid shifts between dialysis sessions, and chronic inflammation. Methods: In 123 HD patients, we examined the relationship between NT-proBNP and interdialytic weight gain, HF with preserved ejection fraction (HFpEF), left ventricular systolic dysfunction (LVSD), and AF, as well as the impact of inflammation. Clinical characteristics, laboratory data, and echocardiography (within three months) were evaluated, while serum NT-proBNP and calprotectin levels were measured by ELISA. Results: NT-proBNP showed no association with interdialytic weight gain and did not identify HFpEF. Inflammatory markers (C-reactive protein and calprotectin) correlated positively with NT-proBNP. Multivariable analysis demonstrated that LVSD, AF, and inflammation remained independent predictors of NT-proBNP levels. Although NT-proBNP levels were higher in LVSD, its diagnostic performance was poor (AUC 0.627). In contrast, NT-proBNP was significantly elevated in patients with AF and showed good diagnostic performance (AUC 0.801). Conclusions: In HD patients, NT-proBNP is not correlated with interdialytic weight gain, performs poorly as a marker of LVSD, but may serve as a useful marker of AF.

Kidney and Dialysis doi: 10.3390/kidneydial6020041

Authors: Joaquín Rodelo-Ceballos Víctor De La Espriella-Palmett Mauricio Restrepo-Escobar Ligia Lorena Calderón Alejandro Román-González

Background: Hungry bone syndrome (HBS) is a frequent and potentially severe complication following parathyroidectomy in patients with chronic kidney disease (CKD) and secondary (SHPT) or tertiary hyperparathyroidism (THPT). We aimed to identify preoperative risk factors associated with the development of HBS in this population. Methods: We conducted a retrospective cohort study including 99 adult patients with CKD-associated SHPT or THPT who underwent parathyroidectomy at Hospital San Vicente Fundación between 2018 and 2024. HBS was defined as corrected serum calcium <8.5 mg/dL requiring intravenous calcium supplementation for at least 72 h postoperatively. Clinical, biochemical, and histopathological variables were evaluated. Multivariable logistic regression analysis was performed to identify independent predictors of HBS, and model discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Results: Overall, 40.4% of patients developed HBS after parathyroidectomy. Compared with patients without HBS, those with HBS more frequently had preoperative musculoskeletal symptoms (82.5% vs. 32.2%), higher preoperative intact parathyroid hormone levels (2135 vs. 1561 pg/mL), and parathyroid adenoma on histology (57.5% vs. 25.4%). In multivariable analysis, preoperative musculoskeletal symptoms (OR 10.92; 95% CI 2.32–51.43) and parathyroid adenoma (OR 6.16; 95% CI 1.38–27.54) were independently associated with increased risk of HBS. Conversely, higher preoperative calcium levels (OR 0.36; 95% CI 0.16–0.85) and the use of calcitriol or vitamin D receptor activators (OR 0.24; 95% CI 0.07–0.81) were protective factors. The final model demonstrated good discrimination (AUC = 0.86; 95% CI 0.77–0.93). Conclusions: HBS is a common complication after parathyroidectomy in patients with CKD-associated SHPT or THPT. Preoperative musculoskeletal symptoms and parathyroid adenoma were associated with increased risk, whereas higher calcium levels and calcitriol/vitamin D receptor activator use appeared protective. Early identification of high-risk patients may facilitate perioperative risk stratification and targeted management strategies.

Kidney and Dialysis doi: 10.3390/kidneydial6020040

Authors: Julian Ananiev Elina Aleksandrova Nedelina Terzieva Iskui Erkanyan Eduard Tilkiyan Milena Nikolova-Vlahova

Background: IgA nephropathy (IgAN) is the most common primary glomerulonephritis, characterized by immune dysregulation and progressive renal injury. Among immunoregulatory mediators, interleukin-6 (IL-6) and interleukin-27 (IL-27) have been implicated in inflammatory and immune processes; however, their combined role in IgAN remains poorly understood. Methods: In this study, serum levels of IL-6 and IL-27 were measured in 51 patients with biopsy-proven IgAN and 62 healthy controls using enzyme-linked immunosorbent assay (ELISA). Associations with clinical and histopathological parameters, including the Oxford MEST-C classification, were evaluated. Results: Serum IL-27 levels were significantly higher in patients with IgAN compared to controls (p = 0.001), while IL-6 levels did not differ significantly between groups (p = 0.820). A positive correlation between IL-27 and IL-6 levels was observed in the patient group (Spearman’s rho = 0.287, p = 0.044). Higher IL-27 concentrations were associated with the absence of mesangial proliferation (p = 0.021) and erythrocyturia (p < 0.001), and showed a trend toward lower proportions of global and segmental glomerulosclerosis. ROC analysis demonstrated moderate discriminatory ability for IL-27 (AUC = 0.708), while the combined IL-6/IL-27 model showed only modest improvement (AUC = 0.661). Conclusions: Our findings suggest that IL-27 may play a modulatory and potentially protective role in IgAN, possibly through attenuation of IL-6–mediated inflammatory pathways.

Kidney and Dialysis doi: 10.3390/kidneydial6020039

Authors: Prettysun Ang Mellow Bendix Samarta Witarto Andro Pramana Witarto I Ketut Adi Suryana Artaria Tjempakasari Widodo Basoeki Djoko Santoso

Introduction: Chronic kidney disease represents a significant global health burden, with dialysis as the most prevalent modality for end-stage kidney disease (ESKD) treatment. One of the major causes of ESKD is diabetes mellitus. Diabetic patients undergoing dialysis have higher mortality risk so optimal timing for its initiation is critical in maximizing survival and quality of life. This study aimed to explore the mortality risk of early versus late dialysis initiation in ESKD patients with diabetes. Methods: Systematic searches were conducted according to the PRISMA 2020 guidelines on PubMed, Scopus, ProQuest, and several databases through Web of Science up to 20 May 2025 (PROSPERO CRD420251074686). Effect sizes were presented as hazard ratios (HRs) with 95% confidence intervals (CIs) and 95% prediction intervals (PIs), pooled using a restricted maximum likelihood random-effects model. Subgroup and meta-regression analyses were also performed to search for potential confounding variables. Results: Eight studies involving 303,116 patients were included. Two studies defined early and late dialysis initiation using an estimated glomerular filtration rate (eGFR) cut-off of 5.0 mL/min/1.73 m2, while the remaining studies used cut-offs ranging from 7.0 to 7.7 mL/min/1.73 m2. The pooled hazard ratio (HR) showed no significant difference in the mortality risk between early and late initiation of dialysis in ESKD patients with diabetes mellitus (HR 1.02, 95% CI 0.79–1.31, p = 0.90, I2 = 97.87%, 95% PI 0.45–2.32). Sensitivity analysis showed that the pooled HR was robust. Subgroup analysis demonstrated no significant difference in the pooled HR according to different study designs. Meta-regressions also showed that the year of population sampling, mean age, and follow-up duration of mortality risk did not have significant associations with the pooled HR. Conclusions: Early dialysis initiation does not appear to confer a survival benefit in ESKD patients with diabetes mellitus. However, given the limited and heterogeneous evidence, further high-quality studies are needed. We suggest that dialysis initiation in this specific population should be guided by clinical indications.

Kidney and Dialysis doi: 10.3390/kidneydial6020038

Authors: Carlos Rebolledo-Maldonado Alberto Polo-Barranco Mary Ramos-Rincón Carlos Martínez-Castillo Ana Barraza-Peña Luz Ceballos-Madrid Dairo Rodelo-Barrios Helman Diaz-Ramírez Valeria Blanchar-Martínez Carlos Beltran-Sánchez José Correa-Guerrero Luis Ariza-Miranda Elber Osorio-Rodríguez

Dengue remains a major public health problem in tropical and subtropical regions, particularly in Latin America. Acute kidney injury (AKI) is one of the severe complications associated with dengue and has been linked to worse clinical outcomes, including prolonged hospitalization, need for renal replacement therapy, and increased mortality. This review aimed to summarize the available evidence on the epidemiology, pathophysiology, clinical manifestations, diagnosis, management, and prognosis of dengue-associated AKI, while also providing an overview of the literature from Latin America. This manuscript was developed as a narrative review. For the Latin America-specific overview, a focused structured search was conducted in PubMed, ScienceDirect, Cochrane Library, LILACS, and Web of Science, including studies published up to December 2025. The available data suggest that AKI in dengue is multifactorial, involving plasma leakage, renal hypoperfusion, endothelial dysfunction, tubular injury, rhabdomyolysis, thrombotic microangiopathy, and inflammatory renal damage. Clinically, AKI has been associated with oliguria, proteinuria, elevated serum creatinine, renal replacement therapy, and higher mortality. Only four eligible indexed studies from Latin America were identified in our search, all from Brazil, with small sample sizes and incomplete reporting of renal outcomes; however, additional unpublished or non-indexed local data may exist. In summary, dengue-associated AKI is a relevant complication of severe dengue, but the evidence available from Latin America remains limited. These findings highlight the need for improved renal surveillance and standardized reporting in dengue-endemic settings across Latin America.

Kidney and Dialysis doi: 10.3390/kidneydial6020037

Authors: Micaela Gentile Valentina Blanco Marta D’Angelo Teresa Valsania Chiara Rocca Roberto Scarpioni

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis frequently associated with serum anti-neutrophil cytoplasmic antibodies (ANCAs), particularly anti-proteinase 3 (PR3). Multisystem involvement is typical, although disease onset with simultaneous manifestations affecting both the ocular and otorhinolaryngologic systems is rare and poorly reported in the literature. We describe a 65-year-old woman with renal impairment with microscopic hematuria and proteinuria and PR3-positive who developed bilateral otitis leading to sensorineural hearing loss and severe anterior scleritis, with a high suspicion of ANCA-associated vasculitis. Despite immunosuppression therapy, persistently elevated serum anti-PR3 levels in the absence of overt clinical activity prompted further diagnostic evaluation, which revealed previously unrecognized subglottic stenosis (SGS), confirmed by MRI, and fully resolved after anti-CD20 therapy. Concurrent involvement of the upper airways and ocular district as the initial presentation of GPA is unusual and may precede renal involvement by several months. Persistent elevation of PR3 levels in an apparent state of clinical remission may indicate ongoing active disease in other anatomical sites. The integration of laboratory tests, imaging studies, and multidisciplinary assessment is essential for early diagnosis and effective therapeutic management.

Kidney and Dialysis doi: 10.3390/kidneydial6020036

Authors: Huzefa Y. Saria Hayley Israel J. Pedro Teixeira Namita Singh Christos Argyropoulos Sara Combs Maria-Eleni Roumelioti

Background: Entrustable Professional Activities (EPAs) that transform competencies into distinct, assessable clinical tasks have not yet been developed for US nephrology fellowships. We created and achieved consensus on a set of nephrology-specific EPAs and aligned them with Accreditation Council for Graduate Medical Education (ACGME) competency standards. Methods: This study was conducted within the University of New Mexico nephrology fellowship program. An initial EPA list was generated by the study team using program objectives, a literature review, and clinician insight. Study participants included eight faculty nephrologists and one nephrology fellow, who completed an online-based three-round modified Delphi consensus-building processes. Each EPA was rated on a five-point Likert scale with consensus requiring strict criteria. Finalized EPAs were independently mapped to ACGME nephrology program requirements. Results: Nine study participants (100% response rate) completed all survey rounds. Through iterative consensus, utilizing strict criteria, a final list of 22 distinct EPAs was created, covering 10 core domains of practice including dialysis management, acute kidney injury, chronic kidney disease, electrolyte abnormalities, hypertension, kidney stones, glomerular disease, pregnancy, transplant care, and education. Finalized EPAs were mapped to 38 different ACGME-required sub-competencies, showcasing diversity and applicability to national expectations. Conclusions: We developed the first consensus-based set of EPAs geared for US nephrology fellowship programs, providing a foundation for standardized assessment and curriculum development that could be implemented across nephrology fellowship programs nationally.

Kidney and Dialysis doi: 10.3390/kidneydial6020035

Authors: Hoai Huong Thi Vo Thanh Van Hoang Nguyen Minh Phuong Thi Phan Tam Vo

Chronic kidney disease–mineral and bone disorder (CKD-MBD) is a major complication of end-stage renal disease and is associated with increased morbidity and mortality. Sclerostin, an osteocyte-derived glycoprotein that inhibits the Wnt/β-catenin signaling pathway, has been implicated in the dysregulation of bone metabolism in dialysis patients. However, comparative data on sclerostin levels and their clinical determinants between hemodialysis (HD) and peritoneal dialysis (PD) patients remain limited, particularly in Southeast Asian populations. This cross-sectional study was conducted at Hue Central Hospital, Vietnam, between June 2023 and January 2026. A total of 89 end-stage renal disease patients were consecutively enrolled (HD: n = 51; PD: n = 38). Median serum sclerostin levels were 584.21 (IQR: 301.18–1479.50) pg/mL in the HD group and 684.21 (IQR: 407.48–940.35) pg/mL in the PD group, with no significant difference between groups (p = 0.839). Serum sclerostin was inversely correlated with PTH in both HD (r = −0.444, p = 0.001) and PD patients (r = −0.341, p = 0.036). In the HD group, total femur BMD showed a significant inverse correlation with sclerostin (r = −0.304, p = 0.030). In multivariable analysis, Log_PTH remained an independent predictor of sclerostin across all three sequential models in the HD group (Model 1: B = −0.340, p = 0.001; Model 2: B = −0.270, p = 0.035; Model 3: B = −0.268, p = 0.039; adjusted R2 range: 0.197–0.217) and in the combined HD + PD cohort (Model 1: B = −0.271, p < 0.001; Model 2: B = −0.263, p < 0.001; Model 3: B = −0.249, p = 0.003; adjusted R2 range: 0.141–0.158). In the PD subgroup, Log_PTH was significant in Models 1 and 2 but not in Model 3; none of the models reached overall statistical significance (all p ≥ 0.081), and findings should be considered exploratory given the limited sample size. Serum sclerostin levels did not differ significantly between HD and PD patients. PTH was the most consistent independent predictor of sclerostin across dialysis modalities and analytical models, underscoring its central role in CKD-MBD pathophysiology. Larger prospective multicenter studies are warranted to validate these findings and further clarify the clinical utility of sclerostin in dialysis populations.

Kidney and Dialysis doi: 10.3390/kidneydial6020034

Authors: Esteban Zavaleta-Monestel José Andrés Castro-Gamboa Luis Guillermo Herrera-Jiménez Sebastián Arguedas-Chacón Jeaustin Mora-Jiménez Kevin Cruz-Mora Sofía Granados-Romero José Miguel Chaverri-Fernandez

References [...]

Kidney and Dialysis doi: 10.3390/kidneydial6020033

Authors: Flore Makaya Talu Therance Tobo Matoka Agathe Bikupe Nkoy Bienvenu Matondo Odio Orielle Mafuta Minimbu Floreen Maluwenze Mumaka Yoli Ngamukuba Ndiyo Dieumerci Kabasele Betukumesu Orly Kazadi wa Kazadi Célestin Ndosimau Nsibu Pépé Mfutu Ekulu

Malaria remains a leading cause of morbidity and mortality among children in sub-Saharan Africa. Acute kidney injury (AKI) is increasingly recognized as a frequent and severe complication of pediatric severe malaria, yet it remains largely underdiagnosed. This under-recognition is driven by important limitations in current diagnostic approaches. The World Health Organization (WHO) criteria rely on fixed serum creatinine (SCr) thresholds that are poorly adapted to children, whereas Kidney Disease Improving Global Outcomes (KDIGO) criteria require baseline SCr (bSCr) values that are rarely available in low-resource settings. The estimation of bSCr using back-calculation methods is further complicated by population-specific factors, particularly malnutrition, which reduces creatinine generation and may mask kidney injury. In addition, urine output (UO) monitoring is often underutilized despite its diagnostic value, and access to laboratory testing remains limited. Emerging biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, and kidney injury molecule-1 (KIM-1) show promise for early detection and risk stratification but remain insufficiently validated in African pediatric populations. In this narrative review, we highlight key challenges in diagnosing malaria-associated AKI (MAKI) in children and discuss potential strategies to improve early detection in resource-limited settings, with the aim of reducing morbidity and mortality.

Kidney and Dialysis doi: 10.3390/kidneydial6020032

Authors: Shreya Jain Shankar Prasad Nagaraju Priya Rani Mohan Varadanayakanahalli Bhojaraja Shriya Narendra Shet Shirodkar Attur Ravindra Prabhu Dharshan Rangaswamy Indu Ramachandra Rao Srinivas Vinayak Shenoy

Background: Chronic kidney disease-associated pruritus (CKD-aP) is characterised as pruritus in individuals with advanced chronic kidney disease (CKD) without a discernible alternative etiology. This study assessed the prevalence, severity, and effects of CKD-aP on sleep and health-related quality of life (HRQoL) among end-stage kidney disease patients (ESKD) undergoing maintenance hemodialysis (MHD) in an Indian cohort. Methods: This cross-sectional, single-centre study included adults with renal failure undergoing MHD for ≥3 months. The primary outcome was CKD-aP prevalence and its relationship with demographic, clinical, and laboratory variables. Secondary outcomes included CKD-aP severity, characteristics, HRQoL, and sleep quality scores. Statistical analysis was conducted using SPSS v21, with a significance level of p < 0.05. Results: The 12-item Pruritus Severity Scale found mild CKD-aP to be the most common (37% of patients). The 5-D Itch Scale found that patients with moderate-to-severe CKD-aP had longer daily itching (52.9%) with a nonsignificant change over time (p = 0.18), and the back (77.9%) was the most affected site. The Dermatology Life Quality Index revealed that 75.5% of patients had HRQoL impairment. The Skindex-16 found that moderate-to-severe CKD-aP was linked to a greater symptom burden and emotional distress. The Pittsburgh Sleep Quality Index found poorer sleep quality as CKD-aP worsened. Conclusions: CKD-aP is common in patients undergoing hemodialysis and negatively impacts quality of life, emphasizing the need for routine assessment and targeted management.

Kidney and Dialysis doi: 10.3390/kidneydial6020031

Authors: Olga Balafa Marianthi Androulaki

Chronic kidney disease (CKD) is a major global health burden associated with substantially increased risks of morbidity and mortality. Cardiovascular disease remains the leading cause of death across all stages of CKD. Over the past few decades, several pharmacologic therapies—including renin–angiotensin system inhibitors, sodium–glucose cotransporter-2 inhibitors, mineralocorticoid receptor antagonists, glucagon-like peptide-1 receptor agonists, and lipid-lowering agents—have demonstrated substantial cardio-nephroprotective benefits and are recommended in international guidelines. However, real-world implementation of these therapies remains incomplete, and emerging evidence highlights important sex-based disparities in prescribing patterns. Although CKD is more prevalent in women worldwide, women with CKD are consistently less likely than men to receive guideline-directed cardioprotective and nephroprotective medications. This treatment gap spans both traditional therapies, such as angiotensin-converting enzyme inhibitors and statins, and newer agents with proven outcome benefits. Women are less likely to initiate treatment, less likely to receive high-intensity or target doses, and less likely to achieve recommended blood pressure and lipid goals. Importantly, the presence of CKD attenuates the usual female survival advantage, and the relative excess cardiovascular risk associated with CKD may be particularly pronounced in women. The under-prescription of cardio-renal therapies in women with CKD reflects a complex interplay of factors. These include older age at presentation, higher reported rates of adverse drug reactions, concerns regarding tolerability and safety in advanced kidney disease, therapeutic inertia, underestimation of cardiovascular risk, and persistent underrepresentation of women in clinical trials. Biological differences in pharmacokinetics and pharmacodynamics, as well as structural and system-level barriers, further contribute to inequities in care. Addressing these disparities requires improved risk recognition, sex-informed prescribing practices, enhanced representation of women in clinical research, and implementation strategies that incorporate sex-disaggregated performance metrics. Reducing treatment gaps is essential to improving cardiovascular and renal outcomes and to achieving equitable, precision-based care for women with CKD.

Kidney and Dialysis doi: 10.3390/kidneydial6020030

Authors: Piotr Wichary Wojciech Wystrychowski Mirosław Śnietura Szymon Białka Hanna Misiołek Antoni Wystrychowski Grzegorz Wystrychowski

Background: Ischemia-reperfusion injury (IRI) impairs kidney transplants. Diazepam can reduce IRI through peripheral benzodiazepine receptors. We aimed to evaluate the effect of diazepam premedication on the IRI of the rat kidney. Methods: Fourteen days after unilateral nephrectomy, male Sprague-Dawley rats underwent a 45 min sole kidney ischemia. Sixty minutes prior to ischemia, the animals were randomly assigned to a subcutaneous injection of 0.75 mg diazepam (n = 28) or 0.5 mL 0.9% NaCl (n = 31). Results: After 48 h, serum creatinine of diazepam-administered rats was lower and creatinine clearance was higher than in controls (119.8 ± 73.3 vs. 217.5 ± 105.3 µmol/L, p < 0.01 and 0.14 ± 0.07 vs. 0.08 ± 0.05 mL/min/100 g BM, p < 0.01, respectively). Moreover, the former had lower urinary losses of sodium and potassium (fractional excretions of 1.24 ± 1.39% vs. 2.87 ± 3.66%, p = 0.02 and 111.1 ± 95.7% vs. 199.0 ± 143.3%, p < 0.01, respectively). After 7 days, diazepam-treated rats remained superior vs. controls, regarding serum creatinine (53.7 ± 12.7 vs. 77.6 ± 21.3 µmol/L, p < 0.01), creatinine clearance (0.22 ± 0.08 vs. 0.17 ± 0.06 mL/min/100 g BM, p < 0.01), potassium sparing (50.2 ± 31.7% vs. 73.4 ± 38.7% excretion, p < 0.01), and renal edema (1.92 ± 0.45 vs. 2.30 ± 0.61 g of kidney mass, p < 0.01). Furthermore, their 24 h proteinuria was marginally reduced (4.03 ± 2.62 vs. 5.06 ± 2.74 mg, p = 0.06). Conclusions: Administration of diazepam preceding renal ischemia attenuates subsequent kidney injury in rats. Benzodiazepines may be beneficial prior to kidney transplantation.

Kidney and Dialysis doi: 10.3390/kidneydial6020029

Authors: Mayra Estacio Matteo Marcello Monica Zanella Claudio Ronco Grazia Maria Virzì

Eryptosis is a programmed cellular death that leads to the removal of defective red blood cells (RBCs). It is driven by convergent intracellular pathways centered on cytosolic Ca2+ overload, ceramide formation, caspase and calpain activation, disruption of membrane phospholipid asymmetry, and the externalization of phosphatidylserine on the cell surface, which marks the cell for clearance by macrophages. In hemodialysis (HD), intermittent extracorporeal circulation exposes erythrocytes to mechanical stress, bio-incompatible membrane surfaces, and rapid osmotic and ionic shifts. Experimental evidence indicates that osmotic shock induces eryptosis through synergistic Ca2+ influx and sphingomyelinase-dependent ceramide generation, providing a mechanistic framework for intradialytic erythrocyte injury. Clinical studies report heterogeneous eryptotic responses during HD, reflecting the balance between toxin removal and procedure-related stress. In contrast, peritoneal dialysis (PD) imposes sustained exposure to hyperosmolar, glucose-based solutions and is strongly influenced by inflammation and residual kidney function. Clinical and experimental data consistently demonstrate increased eryptosis in PD patients, with marked amplification during peritonitis and close associations with inflammatory mediators. This review integrates mechanistic and clinical evidence on eryptosis in HD and PD, highlights modality-specific triggers converging on shared downstream pathways and discusses translational implications and research priorities for improving dialysis biocompatibility and anemia management.

Kidney and Dialysis doi: 10.3390/kidneydial6020028

Authors: Lucas-Gabriel Discălicău Cătălin Baston Bogdan-Marian Sorohan Oana Moldoveanu Silviu Guler-Margaritis Pavel-Mihai Vișinescu Ioanel Sinescu

Background/Objectives: Candidates with cardiometabolic risk are considered for living kidney donation more frequently because of the global organ shortage. The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines introduced individualized risk assessment based on composite donor profiles rather than categorical exclusion, but the long-term implications of accepting donors with potential risk factors require careful evaluation. This review synthesizes current evidence on outcomes of living kidney donors with obesity, prediabetes, hypertension, and smoking. Methods: A literature search was conducted in PubMed/MEDLINE for studies published between 1 January 2000 and 28 February 2026, including cohort studies, registry analyses, meta-analyses, and clinical guidelines evaluating living kidney donors with obesity, smoking, prediabetes, or hypertension. Priority was given to large cohorts with long-term follow-up. Over 70 publications were included in the final synthesis. Findings were synthesized narratively by risk factors and outcomes. Results: Obesity was associated with an 86% increased end-stage kidney disease (ESKD) risk and 32% increased 20-year mortality. Central adiposity measures outperformed body mass index (BMI) for predicting estimated glomerular filtration rate (eGFR) decline. Post-donation weight gain increased the risk for developing hypertension and diabetes. Smoking conferred a 7.5-fold chronic kidney disease (CKD) risk, with impaired compensatory renal adaptation after donation. Prediabetic donors showed comparable outcomes to normoglycemic donors, with 57.8% reverting to normoglycemia at 10 years. Pre-donation hypertension increased 15-year ESKD risk 3-fold, but absolute risk remained low. At 15 years post-donation, over 50% of the donors developed hypertension. Glucagon-like peptide-1 (GLP-1) receptor agonists reduce diabetes progression by 73–94% in at-risk populations, but prospective studies in donors are lacking. Conclusions: Each risk factor carries quantifiable risks for individualized stratification. These risk factors usually coexist and interact. Refinement of risk prediction models, strategies for metabolic optimization and prospective evaluation of emerging pharmacologic therapies are key priorities.

Kidney and Dialysis doi: 10.3390/kidneydial6020027

Authors: Giovanni Tripepi Jolanta Malyszko Michel Jadoul Francesco Locatelli

Randomized controlled trials (RCTs) are the gold standard for evaluating the efficacy and safety of medical interventions. However, the interpretation of their results is often obscured by an overreliance on relative measures of effect, such as relative risk reduction (RRR) and hazard ratios (HRs). While statistically robust, these measures may mislead clinicians and patients when used in isolation. This article provides a methodological framework for the comprehensive interpretation of treatment effects in RCTs, emphasizing the importance of integrating absolute measures such as absolute risk reduction (ARR), number needed to treat (NNT), annualized NNT (aNNT), and number needed to harm (NNH). Additionally, we explore the conceptual differences between risk-based and rate-based measures, the clinical implications of time-to-event analyses, and the utility of composite metrics such as the likelihood of being helped or harmed (LHH). By adopting a multidimensional approach to effect estimation, researchers and clinicians can enhance the translation of statistical findings into meaningful clinical decisions. This approach also facilitates communication with patients.

Kidney and Dialysis doi: 10.3390/kidneydial6020026

Authors: Pietro Dattolo Linda Vignozzi Aris Tsalouchos

Gender medicine represents a key paradigm for advancing equitable and effective healthcare by systematically integrating sex- and gender-related differences into medical research and clinical practice. Despite regulatory efforts and international guidelines, significant gaps persist in the consideration of sex and gender across medical disciplines, including nephrology. Biological factors—including genetic, hormonal, and metabolic differences—interact with social, cultural, and environmental determinants to influence chronic kidney disease (CKD) susceptibility, clinical presentation, progression, and response to therapy. Insufficient consideration of sex and gender contributes to persistent disparities in CKD progression, cardiovascular outcomes, access to kidney transplantation, adverse drug reactions, dialysis outcomes, and pregnancy-related kidney complications. This narrative review outlines the historical development of gender medicine and critically appraises its relevance and unresolved challenges in kidney disease, with a focus on sex-specific differences in selected conditions, including autosomal dominant polycystic kidney disease, glomerular diseases, acute kidney injury, and pregnancy-associated kidney disorders. Integrating sex- and gender-informed approaches into nephrology is not merely an ethical requirement but a scientific necessity to improve risk stratification, personalize therapeutic strategies, and promote truly equitable and effective kidney care.

Kidney and Dialysis doi: 10.3390/kidneydial6020025

Authors: Raul Mancini Emanuele Di Simone Alessio Di Maria Laura Maria Scichilone Elisa Gavazzoli Fina Tedros Fabio Fabbian

Social determinants of health (SDoH) are non-medical factors shaped by the socioeconomic status of individuals or communities that influence the onset and progression of diseases and affect their outcomes. We have narratively analyzed the most important findings relating chronic kidney disease (CKD) and SDoH, evaluating the following items: (i) medical care and social determinants of health, (ii) socioeconomic risk for kidney disease at the individual level and (iii) socioeconomic risk for kidney disease at the population level. SDoH can be categorized by how they influence a person’s daily life. Individual factors include personal lifestyle choices such as smoking habits, alcohol consumption, and how a patient spends their non-working time. Community factors include structural elements such as average household income, educational attainment, employment rates, and the quality of the surrounding physical environment. Research consistently shows that a low socioeconomic status is a primary driver of poor clinical outcomes. While healthcare systems vary globally, the negative impact of socioeconomic deprivation on CKD patients remains a constant. Disadvantaged patients experience a faster loss of renal function, and there is a significantly higher incidence of cardiovascular events and mortality compared to those with financial stability. Financial hardship often leads to a “double burden,” where the struggle to afford care triggers a decline in both physical health and mental well-being. To improve patient care, it is essential to raise awareness among healthcare providers regarding the profound impact of these social factors. More precise data and thorough research are needed to fully understand these associations and develop targeted interventions.

Kidney and Dialysis doi: 10.3390/kidneydial6020024

Authors: Stefano Mancin Gaetano Ferrara Diego Lopane Vittorio Di Maso Alessandro Pizzo Giovanni Cangelosi Gabriele Caggianelli Alessandro Stievano Adriano Friganović Ilaria de Barbieri Sara Morales Palomares Marco Sguanci on behalf of the Italian Society of Nephrology Nurse (SIAN) Research Group on behalf of the Italian Society of Nephrology Nurse (SIAN) Research Group

Background: Chronic Kidney Disease-associated Pruritus (CKD-aP) is a frequent, debilitating, and often underestimated symptom in clinical practice, with significant impacts on quality of life, sleep, mental health, and therapeutic adherence. This study aimed to develop a structured, person-centered nursing care overview for the management of CKD-aP. Methods: A comprehensive narrative review of the recent scientific literature on CKD-aP was conducted, adapting the conceptual domains of the European Specialist Nurses Organisation (ESNO) Common Training Framework (CTF) to nephrology nursing practice. The theoretical model guiding the work was Virginia Henderson’s paradigm, selected for its consistency with care models focused on promoting independence and meeting fundamental human needs. The study would answer the main research question “Which nursing evidence, tools, and strategies can support integrated, patient-centered management of CKD-aP?”. Results: A structured nursing care process was developed, articulated in sequential phases (assessment, problem definition, planning, intervention, and re-evaluation), visually represented in an operational flowchart and supported by validated clinical tools. The model emphasizes the nurse’s role in the multidimensional management of the symptom, incorporating educational, relational, therapeutic, and coordination-focused interventions. Conclusions: This proposal contributes to nephrology nursing practice by providing a theoretical and practical framework to standardize the management of CKD-aP. It promotes a holistic, evidence-based approach tailored to individual care needs, establishing a foundation for future clinical, educational, and research developments.

Kidney and Dialysis doi: 10.3390/kidneydial6020023

Authors: Caleb LeGrand Dinesh Bhattarai Amod Sharma Madison K McGraw Neriman Gokden Lee Ann MacMillan-Crow Nirmala Parajuli

Background: Hypothermic machine perfusion (HMP) has been associated with reduced delayed graft function compared with static cold storage (SCS). However, the molecular mechanisms underlying these differences during cold preservation remain incompletely understood. This study compared cold-storage-related biochemical and histological changes in kidneys preserved by HMP versus SCS using a Lewis rat model prior to transplantation. Methods: Following isolation, rat kidneys were flushed with cold saline (4 °C). Left kidneys were preserved by HMP at constant flow using Belzer’s machine perfusion solution (MPS) at 4 °C, while right kidneys were stored using SCS in University of Wisconsin solution at 4 °C. After four hours of preservation, kidneys were processed for biochemical and histological analysis. Fresh biopsies were evaluated for mitochondrial complex respiration. Western blotting was performed to assess expression of NDUFS3, a complex I subunit. Histological staining for nitrotyrosine and kidney injury markers was compared across groups. Results: Mitochondrial complex respiration did not differ significantly between the SCS and HMP groups. Western blot analysis demonstrated significantly increased NDUFS3 expression in HMP-preserved kidneys compared with SCS and control kidneys. Histological evaluation revealed elevated tubular staining of nitrotyrosine and kidney injury markers in SCS kidneys relative to controls, whereas HMP preservation markedly attenuated these increases. Conclusions: HMP mitigates cold-storage-induced oxidative stress and reduces expression of kidney injury markers after four hours of preservation. These molecular findings suggest a protective effect of HMP during cold preservation. Future studies with longer preservation times and transplantation models are needed to determine whether these improvements translate into enhanced post-transplant kidney function.

Kidney and Dialysis doi: 10.3390/kidneydial6020022

Authors: Ajith M. Nayak Attur Ravindra Prabhu Indu Ramachandra Rao Mohan V. Bhojaraja Dharshan Rangaswamy Srinivas Vinayak Shenoy Shwetha Prabhu Bharathi Naik Shankar Prasad Nagaraju

Accurate dry weight assessment is crucial for hemodialysis (HD) fluid management, yet traditional clinical methods often lack precision. A significant scientific gap exists in the availability of a standardized multimodal framework for integrating objective tools, leaving clinicians without clear guidance on combining results from multiple devices. To address this gap, this narrative review provides a qualitative clinical synthesis of bioimpedance spectroscopy (BIS), lung ultrasound (LUS), and inferior vena cava diameter (IVCD). A structured literature search was conducted across PubMed, Scopus, and CINAHL for English-language studies published between 2012 and 2024. Studies focusing on dry weight assessment using these tools in adult HD patients were included, and findings from 22 core studies were synthesized narratively. BIS and LUS are valuable tools for identifying fluid overload. BIS assesses systemic fluid distribution across compartments, whereas LUS allows non-invasive detection of extravascular lung water. In contrast, IVCD primarily reflects intravascular volume status. While the integrated use of these tools shows potential clinical utility, individual methods, particularly IVCD, require further validation owing to interpatient variability. A multimodal approach that integrates these objective methods with clinical judgment offers a comprehensive evaluation of dry weight. Integrating these assessment strategies may improve outcomes and decision-making in nephrology care.

Kidney and Dialysis doi: 10.3390/kidneydial6010021

Authors: Gabriel Ștefan Nicoleta Petre Simona Stancu

Familial Mediterranean fever (FMF) is a monogenic autoinflammatory disease in which renal involvement is a major determinant of prognosis and is classically dominated by amyloid A (AA) amyloidosis. Non-amyloid renal manifestations are uncommon and poorly characterized. We report a case of clinically overt FMF associated with anti-phospholipase A2 receptor (PLA2R) antibody-positive membranous nephropathy (MN). A 46-year-old man with recurrent febrile episodes fulfilling Tel Hashomer criteria for FMF developed progressive proteinuria with detectable anti-PLA2R antibodies. Genetic testing identified a heterozygous missense MEFV variant in exon 10 (p.Lys695Arg), a mutation with variable penetrance and conflicting pathogenic classification. Kidney biopsy demonstrated PLA2R-positive MN, excluding amyloidosis. After initial conservative management, the patient progressed to nephrotic syndrome complicated by renal vein thrombosis, requiring immunosuppressive therapy according to the Ponticelli regimen in addition to colchicine and anticoagulation, resulting in clinical and immunological remission. In parallel, we performed a systematic review of the literature, identifying only isolated reports of biopsy-proven MN in FMF patients. This case highlights the diagnostic importance of kidney biopsy in FMF patients with proteinuria and illustrates that immune-mediated glomerular disease may occur even in association with non-founder or variably penetrant MEFV mutations, requiring disease-specific management beyond standard autoinflammatory control.

Kidney and Dialysis doi: 10.3390/kidneydial6010020

Authors: David Plappert Nico Schmid Severin Schricker Leonie Kraft Markus Ketteler Jörg Latus Moritz Schanz

Introduction: Glucocorticoid (GC)-sparing treatment strategies, such as the C5a receptor antagonist avacopan, could potentially replace the need for long-term GC therapy in ANCA-associated vasculitis (AAV). Therefore, an assessment of GC-related morbidity is required to provide justification for such therapies. The aim of this study was to assess the incidence and management of common GC-related adverse events. Methods: In this single-center cohort study, medical records were screened for patients with a diagnosis of AAV admitted to the Robert Bosch Hospital (RBK) in Stuttgart, Germany. A total of 74 patients admitted for treatment of AAV between 2004 and 2023 were included. We assessed the dosage and duration of GC therapy used to treat AAV, as well as the incidence of new-onset and worsening arterial hypertension and diabetes mellitus, using over 150,000 individual medication time points for calculation of GC therapy. Additionally, incidence of infections and fractures was recorded. Results: Including relapses, 127 vasculitis events were observed during a median follow-up time of 8.3 years (IQR 5.3–10.6). Median duration of glucocorticoid therapy was 2.9 years (IQR 1.3–5.8). Regarding adverse events, 15 patients (20%) developed new-onset diabetes mellitus and a significantly higher cumulative GC dose was observed in patients requiring insulin therapy compared with those on oral antidiabetics (p = 0.02). Furthermore, 38 (51%) patients were diagnosed with new-onset arterial hypertension. Patients requiring escalation of antihypertensive therapy had significantly higher cumulative GC dose after a vasculitis event (p = 0.0001). A total of 325 infectious events occurred across 69 patients (93%) during follow-up, mostly requiring (85%; n = 277) hospital admission. Cumulative GC dose was significantly higher in patients with documented infections (p = 0.002). Conclusions: GC-related adverse events are common in patients with AAV. This study provides evidence on the incidence of presumably treatment-related harms in AAV and further promotes the importance of reduced-dose or even GC-free treatment approaches.

Kidney and Dialysis doi: 10.3390/kidneydial6010019

Authors: Esteban Zavaleta-Monestel José Andrés Castro-Gamboa Luis Guillermo Herrera-Jiménez Sebastián Arguedas-Chacón Jeaustin Mora-Jiménez Kevin Cruz-Mora Sofía Granados-Romero José Miguel Chaverri-Fernandez

Objective: The objective of this study is to evaluate the efficacy and safety of sodium zirconium cyclosilicate in the treatment of hyperkalemia in adult patients based on the available scientific evidence. Methods: A systematic review of randomized controlled trials evaluating SZC in adult patients with hyperkalemia was conducted, including populations with chronic kidney disease and heart failure and patients undergoing hemodialysis. Outcomes assessed included serum potassium reduction, achievement and maintenance of normokalaemia, and adverse events. Results: Seven randomized controlled trials were included. SZC produced a rapid and significant reduction in serum potassium, with reductions of up to 1.28 mmol/L within 48 h and onset of action observed as early as 1–4 h. Across studies, 63–92% of patients achieved normokalaemia within 24–48 h, and maintenance therapy sustained normokalaemia for up to 28 days and longer in selected populations. The most frequently reported adverse events were mild-to-moderate edema and constipation, while hypokalemia was infrequent (<5% in most studies). Conclusions: Sodium zirconium cyclosilicate is an effective and generally well-tolerated option for the management of hyperkalemia, providing rapid potassium reduction and sustained normokalaemia. However, no randomized controlled trial included in this review demonstrated a significant benefit of SZC over comparators in major clinical outcomes—hospitalizations, cardiovascular events, or mortality; the evidence of clinical benefit is therefore absent from the current randomized trial literature.

Kidney and Dialysis doi: 10.3390/kidneydial6010018

Authors: John Dotis Charalampos Antachopoulos Athina Papadopoulou Nikoleta Printza

Peritoneal dialysis (PD)-related infections caused by rare pathogens are heterogeneous and clinically challenging, and available evidence is largely limited to isolated reports that hinder comparative interpretation. We conducted a controlled pooled narrative synthesis with exploratory comparative analyses of previously published, author-derived literature, designed to compare clinical outcomes across rare pathogen groups using a consistent analytical framework rather than a systematic review or meta-analysis. Infectious episodes were categorized into four groups: Gram-positive bacteria, Gram-negative bacteria, nontuberculous Mycobacteria (NTM) and fungal pathogens (Aspergillus spp.). Primary outcomes were catheter removal and infection-related mortality, while secondary outcomes were analyzed descriptively. In total, 135 infectious episodes were included (17 Gram-positive, 39 Gram-negative, 25 NTM and 55 Aspergillus). Catheter removal occurred in 11.8% of Gram-positive, 12.8% of Gram-negative, 95.8% of NTM and 85.5% of Aspergillus infections, while infection-related mortality was observed only in NTM (4.0%) and Aspergillus infections (38.2%). Exploratory comparisons suggested a gradient of severity across pathogen categories. In conclusion, rare PD pathogens show distinct, pathogen-specific outcome patterns. Rather than a validated prognostic model, we propose descriptive, hypothesis-generating pathogen-based severity tiers that may support early risk appraisal, guide timely decisions regarding catheter salvage versus early removal, and facilitate more tailored, pathogen-informed management in high-risk infections.

Kidney and Dialysis doi: 10.3390/kidneydial6010017

Authors: Tatjana Damjanović Nada Dimković Aleksandar Jankovic Ana Bulatović Jelena Bjedov Bojan Stopic Radomir Naumović

Background: Obesity has reached epidemic proportions and represents a challenge in selecting the optimal renal replacement therapy for patients with end-stage renal disease (ESRD). This study aimed to evaluate the outcomes of peritoneal dialysis (PD) patients according to baseline body mass index (BMI) and to assess the impact of BMI changes during follow-up on PD-related complications and patient outcomes. Methods: This retrospective, single-center study included 53 incident PD patients treated between June 2006 and August 2015. Based on baseline BMI, patients were classified as normal weight (18.5–24.9 kg/m2; n = 17), overweight (25.0–29.9 kg/m2; n = 25), or obese (≥30.0 kg/m2; n = 11). PD adequacy, mechanical and infectious complications, technique survival, and patient survival were assessed over a 48-month follow-up. The effect of BMI changes during follow-up was also analyzed. Results: At PD initiation, total weekly Kt/V was significantly lower in the obese compared with the normal-weight patients (2.0 ± 0.4 vs. 2.3 ± 0.5; p = 0.038), although values remained within the ISPD targets. The normal-weight patients had lower urine output compared with the overweight patients (p = 0.038). Exit-site infections were the most frequent, whereas peritonitis incidence was the lowest in the obese patients, without statistically significant differences. The obese patients demonstrated poorer technique survival and overall survival, again without statistical significance. Mean BMI change after one year was 1.65 ± 2.08 kg/m2, and after 4 years, it was 2.07 ± 3.18 kg/m2. The BMI change was not associated with complications or survival. Conclusions: No significant association during the 48-month follow-up period was observed between baseline nutritional status or weight gain assessed by body mass index and adverse peritoneal dialysis outcomes; therefore, overweight and obese patients can achieve adequate PD performance and may defer or avoid transition to hemodialysis.

Kidney and Dialysis doi: 10.3390/kidneydial6010016

Authors: Lixing Xu Jack Kit-Chung Ng Winston Wing-Shing Fung Gordon Chun-Kau Chan Kai-Ming Chow Cheuk-Chun Szeto

Sarcopenia is characterized by the progressive loss of muscle mass and function, and it represents a significant and prevalent condition in patients undergoing peritoneal dialysis (PD). However, limited research has been conducted to document techniques for the early detection of sarcopenia in adult PD patients. This review addresses the pathophysiology, prognostic implications, and various assessment techniques for sarcopenia, including creatinine kinetics, anthropometry, imaging techniques (computed tomography, magnetic resonance imaging, and ultrasound sonography), bioimpedance spectrometry, and the modified creatinine index. Each of these techniques presents unique strengths and limitations, necessitating careful consideration of the most appropriate assessment method based on specific clinical conditions. By synthesizing current knowledge, this review aims to evaluate the strengths and limitations of available muscle-assessment techniques and assist in the development of improved diagnostic strategies for sarcopenic adult PD patients.

Kidney and Dialysis doi: 10.3390/kidneydial6010015

Authors: Iacopo Daturi Ciro Esposito Emanuela Efficace Giuseppe Sileno Marta Arazzi Marco Colucci Gabriella Adamo Luca Semeraro Paola Baiardi Federico Fassio Fabrizio Grosjean Vittoria Esposito

Background: Ultrasound (US) imaging is widely used in Nephrology for the non-invasive assessment of renal morphology and perfusion. This study investigates correlations between sonographic parameters and renal function measured as estimated glomerular filtration rate (eGFR). Methods: This single-center prospective cross-sectional study enrolled 130 patients undergoing renal ultrasound. Parameters included renal length, parenchymal thickness, cortical–medullary differentiation, renal volume, and intrarenal resistive index (IR). eGFR was calculated using the CKD-EPI formula. Statistical analysis assessed correlations and developed a multivariable predictive model. Results: Renal length and parenchymal thickness correlated positively with eGFR (r = 0.381 and 0.364, p < 0.001), while IR correlated negatively (r = −0.549, p < 0.001). Multivariate regression identified sex, renal length, IR, cortical–medullary differentiation, and solitary/shrunken kidney as significant predictors of eGFR. The final model showed a predictive correlation coefficient of r = 0.6632. Specific ultrasound parameters, particularly renal length and IR, show significant correlation with eGFR. Conclusions: A predictive model incorporating these factors may assist in estimating renal function non-invasively.

Kidney and Dialysis doi: 10.3390/kidneydial6010014

Authors: Tetty Yuniati Fiva Aprilia Kadi Aris Primadi Dwi Oktari Erfanti Johanes Edy Siswanto Ahmedz Widiasta

Background: Chronic kidney disease (CKD) and hypertension in adolescence and young adulthood are predisposing factors for cardiovascular and neurological diseases later in life. Serum creatinine levels have been routinely used as a daily practice modality for detecting acute kidney injury (AKI) in patients of all ages, but unfortunately have some limitations, such as their delayed increase during AKI events. An earlier biomarker is needed to detect AKI, notably in the neonatal period. In the present study, we aimed to determine whether neutrophil gelatinase-associated lipocalin (NGAL) could be used as a modality in detecting AKI, not only in children and adults, but also in neonates. Methods: We conducted a prospective-cohort study on preterm neonates with a gestational age of 28–34 weeks at Hasan Sadikin General Hospital, Bandung, and performed serum NGAL and creatinine measurements. Spearman’s rank correlation was used to determine the association between serum NGAL levels and AKI during the first 48 h in these neonates. Serum NGAL was measured using the Elabscience® Human NGAL ELISA kit; NGAL positivity was defined as serum NGAL > 150 ng/mL for exploratory classification. Results: Serum NGAL measurement showed a better positivity rate in detecting early AKI in neonates than creatinine (KDIGO and nRIFLE), with values of 81.8, 24.7, and 10.4, respectively. Conclusions: NGAL can be used as a modality for detecting AKI earlier in neonates.

Kidney and Dialysis doi: 10.3390/kidneydial6010013

Authors: Sonja Golubović Vladimir Veselinov Vladimir Đurović Nikola Glogonjac Marko Despotović Jagoš Golubović

Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder primarily known for progressive kidney cysts, and it is the most common hereditary syndrome linked to intracranial aneurysms (IAs). Approximately 5–20% of ADPKD patients have IAs (versus ~3% in the general population). Key risk factors for IAs in ADPKD include a family history of aneurysmal subarachnoid hemorrhage (SAH), early-onset or poorly controlled hypertension, and possibly more severe kidney disease (e.g., large total kidney volume and reduced kidney function). The PKD1 and PKD2 mutations in ADPKD lead to polycystin-1/-2 dysfunction in vascular cells, causing intrinsic vessel wall weakness. This weakness—compounded by chronic hemodynamic stress and inflammation—predisposes ADPKD patients to aneurysm formation. Clinically, most aneurysms in ADPKD are small (<7 mm), asymptomatic, and located in the anterior cerebral circulation. Their growth and rupture risk appears similar to aneurysms in non-ADPKD patients; however, ruptures in ADPKD occur at younger ages, underscoring the need for vigilant management. This narrative review provides a nephrology-oriented overview of intracranial aneurysms in ADPKD, including pathophysiology, epidemiology, and clinical management. Key Messages: -ADPKD carries a higher prevalence of intracranial aneurysms (≈5–20%) than the general population (≈3%). Key risk factors include a family history of aneurysm/SAH, early or poorly controlled hypertension, and possibly advanced renal disease. -Guidelines support targeted rather than universal screening, mainly in patients with family history or prior SAH. -Non-contrast MRA is the preferred modality, usually initiated around age 30 in at-risk individuals. -Most aneurysms are small and asymptomatic; small lesions are monitored with BP control and imaging, while larger or high-risk aneurysms are treated prophylactically. -Broader screening remains debated. Future genetic insights may improve risk stratification, but current practice requires balancing rupture prevention against over screening.

Kidney and Dialysis doi: 10.3390/kidneydial6010012

Authors: Ludwig Matrisch Yannick Rau

Background: Kidney biopsy is the diagnostic gold standard for characterizing glomerular disease and other intrarenal pathologies. Despite its clinical importance, epidemiological trends in kidney biopsy incidence remain poorly understood in many developed healthcare systems. This study characterizes temporal and demographic trends in kidney biopsy utilization in Germany between 2006 and 2023, providing crucial data for resource allocation in renal pathology services. Methods: Data on all kidney biopsies (OPS code 1-465.0) performed in German hospitals were extracted from the Federal Statistical Office database and stratified by age and sex. Population denominators were obtained from national census data. Incidence rates per 100,000 inhabitants per year were calculated, and temporal trends were analyzed using Poisson regression with year as a continuous predictor variable. Separate models were fitted for overall population incidence, age-stratified incidence, and sex-stratified incidence. Results: The incidence of kidney biopsies increased 96.6% over 18 years, from 8.59 per 100,000 inhabitants in 2006 to 16.89 per 100,000 in 2023 (IRR: 1.0296 per year, 95% CI: 1.0287–1.0305; p < 0.0001). Age-stratified analysis revealed pronounced heterogeneity, with the oldest patients (>80 years) experiencing the steepest increase of 7.74% annually, while the youngest age group (<20 years) showed no significant temporal change. Sex-stratified analysis demonstrated similar increases in both males and females (3.36% and 3.04% annually, respectively). Conclusion: The substantial increase in kidney biopsy utilization in Germany over nearly two decades mirrors international patterns and suggests a global shift toward more liberal biopsy utilization in aging populations. Multiple factors likely contributed to this increase, including demographic aging, improved procedural safety and accessibility, evolving diagnostic guidelines, and expanding therapeutic options for glomerular disease. These findings underscore the need for national registry systems to optimize resource allocation for renal pathology and ensure equitable diagnostic access across healthcare systems.

Kidney and Dialysis doi: 10.3390/kidneydial6010011

Authors: Kunitoshi Iseki

Salt restriction continues to be suggested in current clinical practice guidelines. While it is useful for the management of hypertension, restriction may be too severe and hazardous for chronic kidney disease (CKD) patients, particularly older patients. Habitual salt intake is different in individuals and influenced by socio-economic conditions, CKD stage, primary renal disease, and co-morbid conditions. Currently, team-based care is recommended with adjustments for individuals. Kaizen, i.e., to begin with one small step, is the best strategy to improve the quality of life of CKD patients. Managing salt intake plays an important role in maintaining adequate nutritional status.

Kidney and Dialysis doi: 10.3390/kidneydial6010010

Authors: María Paloma Flores-Paloma Javier Ramírez-Santos Llenalia Gordillo-García Paula López-Sánchez Manuel David Sánchez-Martos María Eugenia Palacios-Gómez Francisco Javier González-Martínez

Background: Chronic kidney disease (CKD) is increasingly prevalent, leading to more patients requiring hemodialysis. Medium cut-off (MCO) membranes, such as the ELISIO™ HX dialyzer, may enhance middle-to-large molecule removal and reduce inflammation compared with conventional high-flux membranes. This study evaluated the efficacy and safety of ELISIO™ HX versus a standard high-flux dialyzer (Toraylight NS-21S) in terms of molecular reduction rate and inflammation. Methods: We performed a single-center, prospective, randomized crossover study with 12 hemodialysis patients, each treated with Toraylight NS-21S and ELISIO™ HX over four weeks. Pre- and post-dialysis levels of urea, creatinine, albumin, creatine kinase, phosphorus, parathyroid hormone, C-reactive protein (CRP), procalcitonin, interleukin 6 (IL-6), and β2-microglobulin were measured. Pre–post differences were assessed using dialyzer analysis, period-effect and carryover analysis, and non-inferiority analysis. Results: ELISIO™ HX was non-inferior to Toraylight NS-21S for creatinine, urea, phosphorus, procalcitonin, and β2-microglobulin. No significant serum albumin changes were observed with either dialyzer. Adverse events were infrequent and comparable between the dialyzers. Conclusions: ELISIO™ HX appears non-inferior to Toraylight NS-21S and suggests good safety and tolerability. These findings should be interpreted with caution given the study’s limited power.

Kidney and Dialysis doi: 10.3390/kidneydial6010009

Authors: Yasemin Bati Sutcu Seyda Gul Ozcan Mevlut Tamer Dincer Zeynep Atli Sinan Trabulus Nurhan Seyahi

Background: Chronic kidney disease (CKD) is a major global health burden. Patient education is a crucial part of CKD management. Large language models (LLMs) such as ChatGPT and Gemini may help patients access medical information, but their reliability in CKD-related contexts is uncertain. Methods: We collected 291 questions from 100 CKD patients and selected and analyzed 123 of them across three categories: medical condition and treatment, nutrition and diet, and symptom management. Responses from ChatGPT and Gemini were assessed by two nephrology specialists using the Quality Assessment of Medical Artificial Intelligence (QAMAI) scale. Results: When all 123 questions were evaluated together, ChatGPT outperformed Gemini in terms of clarity and usefulness. However, when the questions were analyzed by category, Gemini demonstrated relatively stronger performance in the nutrition and symptom management domains. Accuracy and relevance were comparable between the two models. Neither consistently provided adequate citations. Conclusion: ChatGPT and Gemini demonstrate potential as supplementary tools for CKD patient education, with complementary strengths across different domains. Although they cannot replace clinical expertise, their supervised use could enhance information access and reduce clinician burden.

Kidney and Dialysis doi: 10.3390/kidneydial6010008

Authors: Mariana Dias Pais Ana Gaspar Sílvia Coelho

Therapeutic plasma exchange is a procedure in which plasma is removed and replaced with another fluid to correct blood abnormalities. There is growing evidence of its benefit in certain clinical conditions, including thrombotic thrombocytopenic purpura, hematological diseases, and immune-mediated neurological disorders. Therapeutic plasma exchange prescription includes the choice of technique (centrifugation or membrane filtration) and the choice of vascular access, as well as the total plasma volume to be exchanged, the type of replacement fluid, the number and frequency of sessions, and the method of anticoagulation. These patients may be critically ill and undergo this technique in an intensive care unit, where the intensivist manages the procedure independently or in collaboration with other specialists. We aim to make an easy-to-follow general prescription of this procedure, by offering a practical revision that empowers physicians, such as non-autonomous intensivists, to autonomously prescribe and manage this procedure, reducing delays in initiating treatment and addressing complications.

Kidney and Dialysis doi: 10.3390/kidneydial6010007

Authors: I Ketut Adi Suryana Bendix Samarta Witarto Andro Pramana Witarto Artaria Tjempakasari

Introduction: Temporary non-tunneled catheters are necessary in patients with chronic kidney disease requiring acute hemodialysis care, and complications associated with these catheters, such as infection and thrombosis, represent the most important sources of morbidity. There are no studies available that suggest the optimum duration of their use before catheter exchange or removal. This study aimed to explore the duration of temporary catheter insertion before the occurrence of catheter-related infection and mechanical complications in hemodialysis patients. Methods: Systematic searches were conducted according to the PRISMA 2020 guidelines on four databases up to 1 May 2025 (PROSPERO: CRD420251069657). The study outcome was the occurrence time to catheter-related infection and mechanical complications (thrombosis, obstruction, and kinking, causing dysfunction, failure, or insufficient blood flow) in days, pooled using a single-arm meta-analysis. Mean and 95% confidence interval (CI) were used as the summary statistics. Results: Nine studies involving 1448 participants undergoing hemodialysis using temporary catheters were included. Incidence of infection ranged from 0.7 to 13.58 per 1000 catheter-days. The most common bacterium identified was Staphylococcus aureus and Pseudomonas aeruginosa. The pooled mean time to catheter-related infection from 298 catheters was 15.98 days (95% CI 10.47–21.50; I2 = 97.73%). We also found that the pooled mean time to mechanical complications from 507 catheters was 6.69 days (95% CI 2.49–10.90; I2 = 98.03%). Conclusion: Among patients who developed complications, the mean time from temporary catheter insertion was approximately two weeks to the occurrence of catheter-related infection and one week to mechanical complications. Our finding was consistent with the recommendation of the KDOQI guideline, which suggests limiting catheter duration to typically less than two weeks.

Kidney and Dialysis doi: 10.3390/kidneydial6010006

Authors: Christopher Montoya Marwan Tabbara Lea Tordjman Marie Anne Sosa Efren Chavez

Background: Preserving arm veins is important for arteriovenous fistula (AVF) creation in patients with advanced chronic kidney disease (CKD), as mature AVF is the preferred hemodialysis access. Midline catheters introduced into AVF candidate veins may cause thrombosis, hindering AVF formation. This study aims to determine ultrasonographic rates of midline-associated upper extremity deep venous thrombosis (UE-DVT) or superficial venous thrombosis (SVT) in patients with advanced CKD. Methods: We conducted a prospective study involving subjects with advanced CKD, who had a point-of-care ultrasound-guided midline placed in an arm vein. Within 35 days of midline insertion, participants underwent routine bilateral UE venous duplex ultrasound. The primary outcome was a composite occurrence of UE-DVT/SVT ipsilateral to the midline. Comparative analyses were performed based on patient demographics and device-specific variables. Results: 49 subjects with advanced CKD received midlines. The median midline catheter dwell time was <6 days for 15/49 patients (30.6%). The primary outcome occurred in 15/49 patients (30.6%), mostly asymptomatic thrombosis. No significant associations were found between outcomes and patient or device characteristics. Conclusions: Our study identified frequent use of midlines with short dwell times in subjects with advanced CKD which calls into question proper device selection. In this cohort, midline-associated arm clots were frequent.

Kidney and Dialysis doi: 10.3390/kidneydial6010005

Authors: Irem Hacisalihoglu Aydin Kirolos Ibrahim Hagar Abuelazm Tyler L. Stephenson Eugenia Brikker Rif S. El-Mallakh

Lithium is the most reliable mood stabilizer available for the treatment of bipolar disorder. However, its use is limited by multiple concerns, including acute toxicity. Lithium levels have frequently been key to decisions regarding initiation of dialysis. Following the methodological principles of the Scale for the Assessment of Narrative Review Articles (SANRA), comprehensive searches were conducted across the following databases: PubMed, Embase, Web of Science, and Cochrane Library, without limitations on publication period. In an effort to standardize and objectify the decision to use dialysis, current treatment recommendations discuss clinical presentation but ultimately rely on measured serum lithium levels. Decision making can be improved if it takes into account whether lithium toxicity occurred slowly (which is equivalent to chronic toxicity, so that clinical signs of toxicity exceed expectations of measured lithium levels) or quickly (in which measured lithium levels exceed observed clinical severity). We propose that clinicians consider these factors and suggest that involving a broader interdisciplinary team, including psychiatry, in the decision-making process could enhance outcomes.

Kidney and Dialysis doi: 10.3390/kidneydial6010004

Authors: Asuka Ito Yoshihiro Morishita Atushi Morizane Masaki Okazaki Akihiro Kindaichi Kouki Gatto Yoshiteru Tanaka Kenji Shiino Kenji Ina

Background: Patients undergoing maintenance hemodialysis (HD) have a high risk of developing cardiovascular diseases due to calcification of the heart valves and coronary arteries, which results in a high mortality rate. In particular, aortic stenosis (AS) is an independent risk factor for heart failure-related mortality in patients undergoing HD. Recently, the analysis of digitized heart sounds using artificial intelligence (AI) has promoted the automation of cardiac disease detection and technological advances in diagnostic algorithms. Methods: We retrospectively investigated the 203 consecutive patients receiving HD who had undergone visualized phonocardiography using a regulatory-approved medical device (Japan) between January and May 2025 to detect AS. The usefulness of this phonocardiogram device, which utilizes acoustic analysis and an AI-based automatic diagnostic algorithm named the “Super Stethoscope”, was evaluated for the screening of AS in patients undergoing HD based on comparisons with findings obtained from echocardiography. Results: The results showed a significant correlation between the severity of systolic murmurs determined by the AI-based approach and the peak aortic jet velocity measured in 19 patients diagnosed with AS using transthoracic echocardiography (r = 0.578, p < 0.05). Additionally, for the AI-based diagnosis of AS based on systolic murmurs, the sensitivity and specificity in detecting moderate or severe AS were 0.90 and 0.70, respectively, among the patients undergoing HD. Conclusions: The AI-based diagnostic approach using the ECG-gated phonocardiogram “Super Stethoscope” could be a promising tool for AS screening. Transthoracic echocardiography is recommended in cases classified as grade B or higher by AI-based assessment.

Kidney and Dialysis doi: 10.3390/kidneydial6010003

Authors: Tobias M. Mattesen Subagini Nagarajah Martin Tepel

Background: Matrix metalloproteinases (MMPs) and their inhibitors, tissue inhibitors of metalloproteinases (TIMPs), regulate the extracellular matrix. This study examined messenger RNA transcripts of TIMP2 before and after kidney transplantation. Methods: Transcripts were measured in peripheral blood mononuclear cells from 105 kidney transplant recipients, including AB0-incompatible, AB0-compatible, and deceased donor transplantation patients. Quantitative real-time polymerase chain reaction was utilized. Results: Kidney transplant recipients (72 male; 33 female) were a median of 55 (44–63) years old. The median (interquartile range) of pretransplant TIMP2 transcripts was 0.68 (0.50–0.87) in kidney transplant recipients. In total, 9 out of 72 patients (13%) showed delayed graft function, i.e., need for dialysis within 1 week after transplantation. Preoperative TIMP2 transcripts were significantly lower in kidney transplant recipients who experienced delayed graft function compared to patients with immediate graft function (0.40 (0.32–0.62) vs. 0.68 (0.56–0.87); p = 0.01). There was no association between TIMP2 transcripts and age or gender. TIMP2 median transcripts were 0.73 (0.58–0.88) on the first postoperative day. TIMP2 transcripts were similar on the first postoperative day in patients with delayed graft function and immediate graft function. Conclusions: Preoperative TIMP2 transcripts were lower in patients with delayed allograft function. Future investigations are needed to establish the role of TIMP2 transcripts in transplant pathophysiology.

Kidney and Dialysis doi: 10.3390/kidneydial6010002

Authors: Micaela Anna Casiraghi Anna J. Peired Adele Mitrotti Fiammetta Ravaglia Giuseppe Spatoliatore Francesca Digennaro Loreto Gesualdo Augusto Vaglio

Membranous nephropathy (MN) is an immune complex-mediated glomerular disease defined by sub-epithelial deposits that trigger complement activation and podocyte injury. Its pathogenesis reflects loss of immune tolerance and may present as a kidney-limited autoimmune process or in association with underlying conditions (e.g., malignancy, infection, drugs, or systemic autoimmunity). Current diagnostic work-up integrates circulating antibodies—most commonly anti–phospholipase A2 receptor 1 (PLA2R1)—and kidney biopsy, which remains essential in PLA2R1-negative or atypical presentations and for antigen confirmation when serology is negative. In PLA2R1-negative MN, an expanding list of antigens is being recognized, potentially refining phenotyping and risk assessment; however, dedicated studies remain limited, and the clinical weight of many newly described antigens likely requires further validation before supporting an antigen-based classification. Uneven access to advanced diagnostics particularly affects PLA2R1-negative cases, underscoring the need for centralized testing and the development of reliable non-invasive biomarkers. Treatment has advanced with rituximab and other targeted therapies, but resistant and relapsing cases remain challenging, and the evidence base for PLA2R1-negative forms is comparatively limited. This review summarizes recent diagnostic and therapeutic advances, focusing on PLA2R1-negative MN.

Kidney and Dialysis doi: 10.3390/kidneydial6010001

Authors: Rami Dwairi Khitam Al-Refu Basil Aldiabat Heba Al-Smirat Nidal Awad Alnawaiseh Waleed Alhalabi Yousef M. Al-Saraireh

Background: Gastrointestinal (GI) symptoms are highly prevalent in people receiving dialysis and contribute to malnutrition and poor quality of life. We examined the prevalence and severity of GI symptoms in Jordanian adults with end-stage kidney disease (ESKD) treated with hemodialysis (HD) or peritoneal dialysis (PD). Methods: In this cross-sectional study, consecutive adults with ESKD receiving maintenance HD at Al-Karak Teaching Hospital or PD at Al-Basheer Hospital were interviewed using the validated Arabic Gastrointestinal Symptom Rating Scale (GSRS). Domain and total scores (range 1–7) were compared between modalities; a GSRS total score ≥3 defined at least mild overall GI symptom burden. Results: Among 168 ESKD participants (mean age 43.4 ± 15.3 years; 116 HD, 52 PD), 92.2% reported at least one GI symptom. The prevalence of GSRS-defined symptoms was greater in PD (94.2%) than HD (91.4%). PD was associated with significantly higher mean scores in all GSRS domains (reflux, abdominal pain, indigestion, diarrhea, constipation) and a higher total GSRS score (3.33 ± 1.36 vs. 2.36 ± 0.71; p < 0.01 for all comparisons). Upper GI bleeding (UGIB) requiring hospitalization after dialysis initiation occurred more often in HD than PD (15.5% vs. 3.8%; OR 4.59; 95% CI 1.03–20.58). Conclusions: This study demonstrated that dialysis patients had a high prevalence of GI symptoms, with an elevated severity in patients on PD. These findings highlight the need for routine structured assessment of GI symptoms and modality-specific management strategies in dialysis units, particularly for patients on PD.

Kidney and Dialysis doi: 10.3390/kidneydial5040059

Authors: Leidy Yohana Apolinar Joven Brayan Esneider Patiño Palma Eliana Correa Díaz Isabel Cristina Ángel Bustos

Background: Handgrip strength (HGS) is a simple, low-cost indicator of muscle function and predictor of morbidity and mortality in patients with chronic kidney disease (CKD). Objective: To establish sex- and age-specific normative values for HGS in Colombian patients undergoing hemodialysis and to examine its association with clinical and biochemical factors. Methods: A multicenter, cross-sectional study was conducted between August and September 2023 in five cities across Colombia. A total of 436 hemodialysis patients aged 15 to over 80 years were assessed. HGS was measured post-dialysis using a CAMRY EH101 digital dynamometer in both flexion and extension of each arm. The Box–Cox Power Exponential (BCPE) model within the GAMLSS framework was used to generate percentile curves by sex. Comparisons were performed by sex, diabetes status, and occupation. Spearman’s correlation was used to explore associations between HGS and biochemical variables. Results: Males exhibited significantly higher HGS than females (mean difference: 8.09 kg; p < 0.001). Lower HGS was observed among individuals with diabetes and those unemployed. HGS showed a moderate inverse correlation with alkaline phosphatase (r = −0.29, p = 0.0014) and a weak inverse correlation with KT/V (r = −0.22, p = 0.02). No other biochemical markers showed significant associations. Reference percentiles (P3 to P97) were constructed for both sexes. Conclusions: These normative values for HGS represent the first reference standards for Colombian patients on hemodialysis. HGS assessment may support early identification of functional impairment and inform clinical decisions related to rehabilitation and nutritional support.

Kidney and Dialysis doi: 10.3390/kidneydial5040058

Authors: Giovanni Tripepi Graziella D’Arrigo

We read with great interest the recent paper by Campese (2025) [...]

Kidney and Dialysis doi: 10.3390/kidneydial5040057

Authors: Jonathan Mutombo Muamba Joëlle Claudéon Arriel Bunkete Makembi Batcho Jimy Gerard Dalvius Jean-Robert Makulo Christian Lusunsi Kisoka Yannick Mayamba Nlandu Ernest Kiswaya Sumaili Nazaire Mangani Nseka Befa Notokadoukaza

Background: Kidney transplantation activity at the University Hospital of Guadeloupe was briefly interrupted at the onset of the COVID-19 pandemic, reflecting the global impact of this health crisis on organ transplantation. This study assessed patient and graft recovery in 335 recipients transplanted between 2013 and 2023, comparing those transplanted before 2020 and after the resumption of activity. The objective was to evaluate changes in recipient profiles, surgical parameters, and post-transplant outcomes following this disruption. Methods: This retrospective cohort included all kidney transplants performed at the University Hospital of Guadeloupe over a ten-year period. Most patients (70%) received transplants before 2020, with 30% afterward. All grafts were ABO-compatible, and 98.2% were from deceased donors. Trends in transplant activity were analyzed to identify variations over time, with a peak observed in 2018, followed by a decline until 2021 and a progressive recovery from 2022. Comparative analyses were performed to examine disparities in donor and recipient characteristics, ischemia durations, and outcomes between the two periods. Results: After 2020, recipients were more likely to be elderly (≥70 years), immunized, obese, have heterozygous sickle cell disease, or have polycystic kidney disease (p < 0.05). Mean cold ischemia time decreased (p = 0.009), while warm ischemia time increased (p < 0.001), reflecting procedural and logistical adaptations. Graft survival remained stable, with 97.5% at 6 months and 89.8% at 4 years for transplants before 2020, versus 100% and 96.9%, respectively, after 2020 (p = 0.160). Patient survival did not differ significantly between periods (p = 0.199). Independent factors associated with mortality included recipient age ≥ 60 years, diabetes, graft failure, transplantation before 2020, cold ischemia time ≥ 1200 min, and graft pyelonephritis. Conclusions: Despite the temporary suspension of activity and an increased proportion of transplants with expanded criteria after 2020, graft recovery and patient survival were not adversely affected. These findings suggest that kidney transplantation in Guadeloupe demonstrated strong resilience and capacity for adaptation during and after the COVID-19 crisis, maintaining outcomes comparable to the pre-pandemic period.

Kidney and Dialysis doi: 10.3390/kidneydial5040056

Authors: Anupam Choudhary A. V. B. Krishnakanth K. R. Surag Kasi Viswanath Abhijit Shah Sunil Pillai Padmaraj Hegde

Background: Delayed graft function (DGF) is a frequent early complication after deceased donor kidney transplantation (DDKT), leading to prolonged hospitalization, increased risk of acute rejection, and reduced graft survival. Reliable and easily measurable preoperative biomarkers for DGF prediction remain limited. This study aimed to evaluate the predictive value of pre-operative Absolute Eosinophil Count (AEC) and Albumin-to-Globulin Ratio (AGR) for DGF in DDKT recipients. Methods: A retrospective analysis was conducted on all DDKT procedures performed at our institution between January 2018 and December 2023. Patients were divided into two groups: Group 1 (DGF) and Group 2 (non-DGF). DGF was defined as the requirement for hemodialysis within the first seven postoperative days. Demographic, clinical, and laboratory data—including pre-operative AEC and AGR—were collected and compared between groups. Statistical analysis was performed using appropriate parametric and nonparametric tests. Receiver operating characteristic (ROC) curves were generated to assess the individual and combined predictive performance of AEC and AGR for DGF. Results: A total of 38 patients underwent DDKT, comprising 27 males (71.05%) and 11 females (28.95%), with a mean age of 43.3 ± 9.41 years. Fifteen patients (39.47%) developed DGF. The mean AEC and AGR were significantly lower in the DGF group compared to the non-DGF group (AEC: 0.20 ± 0.16 vs. 0.40 ± 0.35, p = 0.04; AGR: 1.43 ± 0.22 vs. 1.66 ± 0.39, p = 0.02). ROC analysis demonstrated that both AEC (p = 0.04) and AGR (p = 0.04) were significant predictors of DGF. Combining both parameters resulted in a higher area under the curve (AUC), improved sensitivity, and enhanced negative predictive value (NPV) compared to either marker alone. Conclusions: DGF occurred in nearly two-fifths of DDKT recipients in this cohort. Patients with lower preoperative AEC and AGR were more likely to develop DGF, suggesting that these easily available hematological and biochemical indices can serve as potential preoperative predictors of early graft dysfunction. Future multicentric prospective studies are warranted to validate these findings and explore their integration into DGF risk prediction models.

Kidney and Dialysis doi: 10.3390/kidneydial5040055

Authors: Giovanni Somma Chiara Ruotolo Maria Rita Auricchio Antonio Cappiello Michele De Luca Lucio Selvaggi Francesco Maria Romano Federica Capozzi Federica Marzano Silvio Borrelli Luca De Nicola Carlo Garofalo

Background: The peritoneal dialysis (PD) catheter is commonly placed using an open surgery approach. However, mechanical peritoneal catheter-related complications are common causes of peritoneal dialysis technical failure. In recent years, laparoscopic procedures have been recommended because of less invasiveness and high effectiveness in reducing catheter dysfunction; however, this approach is burdened by higher costs and higher risks related to general anesthesia. Methods: We have developed a new advanced video-laparoscopy (ALS) approach with a simple technique that does not require general anesthesia. By using an ultrasound-guided procedure it is possible to place a PD catheter by regional anesthesia (Transversus Abdominis Plane (TAP) block associated with bilateral quadratus lumborum (QLB) block). Results: We here report the outcomes of 20 patients who underwent ALS implantation of straight-neck, double-cuffed Tenckhoff catheters using cutaneous anesthesia with TAP and QLB block. No major complications, including bleeding, were reported. No patient needed intravenous treatment for pain control, and all procedures were well tolerated. During a median follow-up of 21 months [IQR, 15–35] no mechanical complication was reported. Conclusions: ALS without general anesthesia is a simple and well-tolerated technique that can be used in patients at high risk. It therefore allows recruiting a greater number of patients for PD and ensuring well-performing catheters with lower risk of mechanical complications.

Kidney and Dialysis doi: 10.3390/kidneydial5040054

Authors: Ana Mijušković Jelena Pavlović Vladimir Cvetić Borivoje Lukić Ana Bontić Selena Gajić Kristina Filić Ivana Mrđa Aleksandar Sič Nikola Trnić Marko Baralić

Background: Renal arteriovenous malformations (rAVMs) are rare vascular anomalies that may lead to hematuria, anemia, or acute kidney injury (AKI). Although endovascular embolization is the treatment of choice, post-procedural complications such as new-onset proteinuria may occur and require long-term management. Case Presentation: A 56-year-old man with recurrent gross hematuria and elevated serum creatinine (128 μmol/L) was diagnosed with a right rAVM and underwent successful selective embolization. Despite recovery of renal function, follow-up revealed new-onset proteinuria (2.2 g/24 h). Results: Introduction of an angiotensin-converting enzyme inhibitor (ACEi) resulted in partial improvement of proteinuria, while subsequent addition of a sodium–glucose cotransporter-2 inhibitor (SGLT2i) achieved almost complete resolution of proteinuria (0.33 g/24 h) and stable renal function (serum creatinine 93 μmol/L) after 12 months. Conclusions: This case highlights the occurrence of post-embolization proteinuria and illustrates the synergistic renoprotective effect of combined ACEi and SGLT2i therapy in a non-diabetic patient with vascular kidney disease.

Kidney and Dialysis doi: 10.3390/kidneydial5040053

Authors: Maria Riastuti Iryaningrum Nanny Natalia Mulyani Soetedjo Noormarina Indraswari Dessy Agustini Yunia Sribudiani Rudi Supriyadi

Hypertension (HTN) and chronic kidney disease (CKD) are significant global health burdens, with microalbuminuria (MA) serving as a key early marker of renal damage and cardiovascular risk. While nutritional interventions are pivotal for management, the evidence for specific nutrients is often complex and inconsistent, creating challenges for clinical guidance. This review critically evaluates current evidence on the interaction among macronutrients, micronutrients, and established dietary approaches and their influence on the development and course of HTN and MA. Strong consensus is present regarding sodium restriction, increased intakes of potassium, and the implementation of dietary patterns like Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet to improve blood pressure and renal outcomes. Evidence favors protein moderation (approximately 0.8 g/kg/day), especially from plant sources, and emphasizes carbohydrate quality (e.g., high fiber, low glycemic index) over absolute quantity. The role of micronutrients is more nuanced; maintaining vitamin D sufficiency is protective, but intervention trials for many supplements, including B vitamins and antioxidant vitamins (C and E), have yielded inconsistent results. Several minerals, such as iron and selenium, exhibit a U-shaped risk curve where both deficiency and excess are detrimental, highlighting the risks of unselective supplementation. Ideal nutrition care prioritizes holistic dietary patterns over a focus on single nutrients. Clinical guidance should be founded on sodium reduction and potassium-rich foods, with personalized recommendations for protein and micronutrient supplementation based on an individual’s specific cardiovascular and renal profile. Future research must target nutrients with conflicting evidence to establish clear, evidence-based intake guidelines.

Kidney and Dialysis doi: 10.3390/kidneydial5040052

Authors: Kyle Chu Pei Li Irfani Ausri Bernardo Cañizares Cesar Vasconez Zilei Guo Xiaowu (Shirley) Tang

Hemodialysis (HD) technology, pivotal in managing end-stage kidney disease, has witnessed significant advancements. Yet, the high cost of novel equipment often restricts its usage in resource-limited settings. This study introduces a two-filter adaptation to conventional HD machines, aimed at enhancing toxin removal while maintaining cost-effectiveness. Using a benchtop experimental setup, the performance of the adapted system was compared with that of standard HD. The results demonstrated that the two-filter system improved urea clearance rates by 54% compared with standard HD, without increasing albumin loss or causing additional hemolysis. In a pilot study of four HD patients, the modified setup achieved a higher single-pool Kt/V (1.82) and urea-reduction ratio (80%). These findings underscore the potential of this adaptation to enhance HD machine efficiency without additional patient risks, thereby offering a feasible solution for improving access to advanced renal therapies in under-resourced areas. Further clinical trials with larger populations are warranted to validate these benefits and evaluate middle-molecule clearance for comparison with hemodiafiltration (HDF).

Kidney and Dialysis doi: 10.3390/kidneydial5040051

Authors: Kenji Ina Miki Tenma Shinya Makino Toshie Yonemochi Miki Nagasaka Megumi Kabeya Yoshihiro Morishita Daisuke Fuwa Takayuki Nanbu Ayako Takahashi Kazuhiro Ito Yoshihiro Ohta

Background: Oral frailty is a new concept, introduced in Japan in 2013. In our preliminary study, oral hypofunction was observed in more than half of patients undergoing maintenance hemodialysis (MHD). This allowed us to determine the exact prevalence of oral frailty in MHD patients and investigate the association between oral cavity function, findings obtained via comprehensive geriatric assessment, and motor features. Methods: We initiated a two-week hospitalization program for MHD patients to evaluate frailty including oral cavity functions. Along with a comprehensive geriatric assessment and evaluation of motor functions, seven items pertaining to oral cavity functions were assessed by a professional dentist to determine oral frailty. After the incidence of each item had been determined, the association between these factors was retrospectively analyzed to explore the factors that affect oral frailty. Results: Oral frailty was observed in 33 out of 50 patients (66%). In particular, tongue lip motor functions were frequently impaired in this population. Oral cavity function scores, which increased as oral function deteriorated, negatively correlated with cognitive function (r = −0.349; p = 0.0129; 1−β = 0.71) and grip strength (r = −0.364; p = 0.00933; 1−β = 0.75). Conclusions: Oral frailty was commonly observed in MHD patients. We are currently considering implementing exercise programs to improve tongue lip motor function, enhance cognitive function through interprofessional cooperation, and strengthen grip.

Kidney and Dialysis doi: 10.3390/kidneydial5040050

Authors: Mahmoud Elshehawy Alaa Amr Abdelgawad Patrick Anthony Ball Hana Morrissey

Background: Diabetic ketoacidosis (DKA) in patients with kidney failure receiving dialysis presents a formidable clinical challenge. Standard DKA protocols, designed for patients with preserved renal function, often fail in this cohort and can be unsafe when applied without modification. Patients are at risk of iatrogenic fluid overload, dyskalaemia, and hypoglycaemia due to altered insulin kinetics, impaired gluconeogenesis, and the absence of osmotic diuresis. Purpose: This narrative review aims to synthesise current understanding of DKA pathophysiology in dialysis patients, delineate distinct clinical phenotypes, and propose individualised management strategies grounded in physiology-based reasoning, comparative guideline insights, and consensus-supported literature. Methods: We searched PubMed/MEDLINE, Embase, and Google Scholar (January 2004–June 2024) for adult dialysis populations, using terms spanning DKA, kidney failure, insulin kinetics, fluid balance, and cerebral oedema. Reviews, observational cohorts, guidelines, consensus statements, and physiology papers were prioritised; case reports were used selectively for illustration. Evidence was weighted by physiological plausibility and practice relevance. Nephrology-led authors aimed for a pragmatic, safety-first synthesis, seeking and integrating contradictory recommendations. Conclusions: Our findings highlight the critical need for a nuanced approach to fluid management, a tailored insulin strategy that accounts for glucose-insulin decoupling and prolonged insulin half-life, and careful consideration of potassium and acidosis correction. We emphasise the importance of recognising specific volume phenotypes (hypovolaemic, euvolaemic, hypervolaemic) to guide fluid therapy, and advocating the judicious use of variable-rate insulin infusions (‘dry insulin’) to mitigate fluid overload. We also show that service-level factors are critical. Dialysis-specific pathways, interdisciplinary training, and quality improvement metrics can reduce iatrogenic harm. By linking physiology with workflow adaptations, this review provides a physiologically sound, bedside-oriented map for navigating this complex emergency safely and effectively. In doing so, it advances an individualised model of DKA care for dialysis-dependent patients.

Kidney and Dialysis doi: 10.3390/kidneydial5040049

Authors: Muhammad Nauman Hashmi Fayez Hejaili Syed Hammad Raza Muhammad Anwar Khan

Background: Despite efforts to rely on arteriovenous fistulas/grafts for maintenance hemodialysis, a significant number of patients still depend on tunnel hemodialysis catheters for treatment. This poses a risk factor for central line-associated bloodstream infection (CLABSI) and, subsequently, vascular access compromise. Method: We conducted a retrospective study in five dialysis centers to determine the potential factors resulting in vascular access loss, CLABSI incidence, and microbe distribution patterns in Saudi Arabia at centers under the Ministry of National Guard Health Affairs. Adults who regularly received hemodialysis and had positive blood cultures between January 2019 and December 2023 were the subjects of the study. Results: Our study identified the presence of tunnel infection (p < 0.001), the presence of a Gram-negative pathogen (p = 0.036), and a high body mass index (BMI > 30) (p = 0.04) as potential risk factors leading to the loss of tunnel central venous catheters. In contrast, there was a lower probability of central venous catheter loss due to Gram-positive pathogens (p = 0.01). The CLABSI rate was 1.55 per 100 patients per month over a five-year period. Patients with CVC required more hospital treatment and had a significantly higher rate of vascular access loss (p < 0.001). Both central and peripheral blood cultures had nearly identical microbe spectra. Methicillin-sensitive Staphylococcus aureus (MSSA), Methicillin-resistant Staphylococcus aureus (MRSA), and Staphylococcus epidermidis had the highest prevalence rates among Gram-positive organisms. Among the Gram-negative bacteria, Enterobacter cloacae was the most common, followed by Klebsiella pneumonia and Pseudomonas aeruginosa. Conclusions: Our findings indicate the need for rigorous measures and interventions to prevent Gram-negative infections and decrease the reliance on central venous catheters, to decrease infections in hemodialysis patients, and decrease morbidity and cost. Strict hand hygiene, patient education, and surveillance programs are recommended to monitor these patients.

Kidney and Dialysis doi: 10.3390/kidneydial5040048

Authors: Udit Nangia Prathap Simhadri Neeraj Mahajan Deepak Chandramohan Nihar Jena Hari Naga Garapati

Introduction: Allogeneic hematopoietic cell transplantation (allo-HSCT)-associated thrombotic microangiopathy (TA-TMA) and pre-transplant renal dysfunction are recognized risk factors for mortality after allo-HSCT. Utilizing the data from the Center for International Blood and Marrow Transplant Research (CIBMTR), we investigated the association between onset of TA-TMA and pre-HSCT renal dysfunction on renal failure requiring dialysis (RFD). Methods: We evaluated TA-TMA as a time-dependent covariate in a multivariate Cox regression model for RFD in Allo-HSCT recipients aged ≥ 40 years between 2008 and 2016. Pre-HSCT patients were divided into two groups, estimated GFR (eGFR) < 60 mL/min/1.73 m2 group and eGFR ≥ 60 mL/min/1.73 m2. Cumulative hazards of RFD in patients with and without onset of TA-TMA were estimated. Results: TA-TMA was significantly associated with increased risk (6.6-fold compared to No TA-TMA) for RFD, the highest of all the significant risk factors. The estimated cumulative hazard for patients with TA-TMA in the two pre-HSCT renal function groups was significantly elevated when compared to similar patients with no TA-TMA (80% vs. 12% for eGFR < 60 mL/min and 50% vs. 5% for eGFR ≥ 60 mL/min group, respectively) at 12 months post-HSCT. Conclusions: Our results demonstrate that the adjusted HR of renal failure requiring dialysis and cumulative hazard was much higher in patients with onset of TA-TMA, especially among patients with pre-existing renal dysfunction, underscoring the importance of early recognition and risk-adapted management.

Kidney and Dialysis doi: 10.3390/kidneydial5040047

Authors: Bozhidar Vergov Yordan Sbirkov Kostadin Yordanov Dimitrov Violeta Zheleva

The incidence of kidney diseases has been increasing in the last decade due to extended lifespan, which is often related to polymorbidity. Chronic kidney disease (CKD) and acute kidney injury (AKI) are associated with high morbidity and mortality, elevated costs for renal replacement therapy, and heavy psychosomatic burden. At the same time, therapeutic options are limited to prophylactic and renoprotective medications and measurements, and they often cannot restore the impaired kidney function. With the development of cellular therapies, new perspectives arise on the horizon with promising potential, including mesenchymal stem cells (MSCs) and induced pluripotent cells (iPSCs). Here we review the current possibility of both cell types in the field of nephrology and assess their cost implication.

Kidney and Dialysis doi: 10.3390/kidneydial5030046

Authors: Alexandru-Andrei Ujlaki-Nagi Ludovic-Alexandru Szanto Elena Florea Nicolae-Alexandru Lazar Suzana-Vasilica Șincaru Adrian Vasile Mureșan Eliza Russu Réka Bartus Eliza-Mihaela Arbănași Ioan Hosu Marius Mihai Harpa Claudiu Constantin Ciucanu Emil-Marian Arbănași

We report the case of a 44-year-old man with end-stage kidney disease (ESKD) who has been on chronic hemodialysis via a radio-cephalic arteriovenous fistula (RC-AVF) for one year. The patient arrived at the emergency department due to an inability to continue dialysis through the AVF. Clinical and ultrasound exams reveal an aneurysm in the cephalic vein, measuring 2.3 cm (cm) in diameter and 5 cm long, located in the middle third of the forearm, with intraluminal thrombosis. A surgical procedure is planned to exclude the aneurysmal segment and reconnect the vein, using a graft made from a bovine pericardium patch. Immediately after surgery, a thrill is detectable, and ultrasound shows a flow rate of 651 mL/min. On the second day, dialysis is performed through the distal cephalic vein segment under ultrasound guidance, avoiding the median forearm zone. At one month, the fistula remains functional, with no signs of thrombosis or stenosis. The bovine pericardium tubular graft has shown complete integration. This case supports the feasibility, safety, and potential advantages of using a tubularized bovine pericardial graft as an alternative conduit for RC-AVF reconstruction in select patients. However, further studies on larger cohorts and with extended follow-up are necessary to validate its reproducibility and long-term patency.

Kidney and Dialysis doi: 10.3390/kidneydial5030045

Authors: Mahmoud Elshehawy Alaa Amr Abdelgawad Mirza Yasar Baig Hana Morrissey Patrick Anthony Ball

Hypomagnesaemia, a common complication ranging from 20% to over 90%, depending on the diagnostic criteria and population studied, significantly contributes to adverse outcomes, including new-onset diabetes after transplantation, cardiovascular complications, neurological dysfunction and increased infection risk. A total serum magnesium below 0.70 mmol/L is commonly used to define deficiency. In kidney transplant recipients, calcineurin inhibitors downregulate TRPM6 in the distal nephron, leading to early and persistent hypomagnesaemia with links to adverse metabolic and cardiovascular outcomes. Arrhythmia risk rises steeply at total magnesium of <0.50 mmol/L, while neuromuscular irritability and neuropsychiatric symptoms may appear at levels below 0.70 mmol/L. Severe manifestations, such as seizures or tetany, usually occur at ≤0.50 mmol/L and coma at <0.30 mmol/L. Normal ionised magnesium is typically ~0.48–0.65 mmol/L; transplant-specific intervention thresholds remain unvalidated. This narrative review addresses critical diagnostic gaps and explores emerging therapeutic strategies. It highlights three areas: the diagnostic accuracy of ionised magnesium over total magnesium, the critical role of pharmacogenomics in individualising immunosuppression to mitigate tacrolimus-induced hypomagnesaemia and the promising link between gut microbiome modulation and magnesium homeostasis. The implications of these insights are profound: enabling more precise diagnosis and personalised management, reducing the incidence and severity of hypomagnesaemia-related complications, and ultimately supporting more precise diagnosis and personalised management; prospective validation in transplant cohorts is required before outcome claims can be made. This review exposes current diagnostic and therapeutic limitations, advocating for more precise and personalised strategies to address this critical electrolyte imbalance. Identifying hypomagnesaemia as a mechanistically complex and clinically undertreated complication, this review proposes a thematic roadmap that serves as a scientific and clinical framework for advancing personalised electrolyte care in renal transplantation. It is emphasised that while these approaches appear promising, most remain under-evaluated or hypothesis-generating. Addressing hypomagnesaemia through validated thresholds, new research is required to test novel diagnostics and personalised strategies to improve patient and graft outcomes.

Kidney and Dialysis doi: 10.3390/kidneydial5030044

Authors: Ana Rita Martins Maria Teresa Moreira Andreia Lima Salomé Ferreira Marta Campos Ferreira Carla Silva Fernandes

Objective: This scoping review synthesized and mapped the breadth of the existing literature on technological resources used to support individuals undergoing hemodialysis treatment. Methods: Following the methodological guidelines of the Joanna Briggs Institute (JBI) for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist, comprehensive searches were conducted across the following databases: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Scopus, Scientific Electronic Library Online (SciELO), MedicLatina, and the Cochrane Central Register of Controlled Trials, with no time restrictions. Results: Thirty-nine studies conducted between 2003 and 2023 met the inclusion criteria. These studies covered a range of technological innovations developed specifically for hemodialysis treatment, including virtual reality, exergames, websites, and mobile applications. These technologies were designed with diverse objectives: to facilitate physical exercise, optimize dietary and medication management, improve disease adherence and management, and promote self-efficacy and self-care in patients. Conclusions: The review revealed a wide range of technological resources available to hemodialysis patients. These digital solutions show great potential to transform care by promoting more engaged and personalized health practices. Although this study did not directly assess the impact of these technologies, it provides a solid foundation for future investigations that can explore in-depth how such innovations contribute to effective disease management and improvement in clinical outcomes.

Kidney and Dialysis doi: 10.3390/kidneydial5030043

Authors: Shreepriya Mangalgi Vijay Joshi Madhukar Misra Kunal Chaudhary

Residual kidney function (RKF) plays a crucial role in improving outcomes for dialysis patients. Enhanced middle molecular clearance has been proposed as one of the several benefits of preserved RKF. Most patients who start dialysis retain some residual kidney function, providing a rationale for using incremental dialysis. RKF has been associated with mortality benefit in both peritoneal dialysis (PD) and hemodialysis (HD). It also influences technique longevity and lowers peritonitis rates in patients on PD. In both dialysis modalities, RKF improves volume management and blood pressure control. Additional potential benefits include reduced dietary restrictions, improved nutritional status, better quality of life (QOL), reduced erythropoiesis-stimulating agent (ESA) requirements, lower inflammatory marker levels, and improved bone health. RKF is less frequently measured in HD patients primarily due to the lack of standardized methods and logistical challenges. Several equations for estimating RKF have been proposed, but none are widely adopted in clinical use. Historically, HD was believed to cause a rapid loss of RKF; however, more recent data have challenged this view. Future research should focus on identifying factors that affect RKF, standardizing measurement methods, and developing strategies for preservation. Efforts to preserve RKF should be made for all dialysis patients, regardless of modality.

Kidney and Dialysis doi: 10.3390/kidneydial5030042

Authors: Satriyo Dwi Suryantoro Mochamad Thaha Bagus Aulia Mahdi Mutiara Rizky Haryati Ulinnuha Qurrota A’yunin

Several studies have shown an association of fibroblast growth factor-23 (FGF-23), 25-hydroxyvitamin D (25(OH)D), and asymmetric dimethylarginine (ADMA) with the pathogenesis of albuminuria. However, the direct relationship of these biomarkers with albuminuria independent of other risk factors for chronic kidney disease (CKD) remains controversial. FGF-23 and ADMA levels were associated with the progression of CKD, with a cutoff value of ≥100 RU/mL for FGF-23 and 0.69 μmol/L for ADMA. Background/Objectives: To analyze the correlation between FGF-23, 25(OH)D, and ADMA levels and albuminuria. Methods: This was an observational analytic study with a cross-sectional design conducted in patients with CKD with various disease stages (non-dialysis). The output is albuminuria. Statistical analysis was performed using multivariate logistic regression analysis. Results: This study included 107 patients with CKD stages 2–5 with an average age of 57.32 years. Their average FGF-23, vitamin D, ADMA, and uACR levels were 197.75 RU/mL, 23.44 ng/mL, 0.719 µmol/L, and 940 mg/g, respectively. FGF-23 was weakly correlated with uACR (r = 0.252; p = 0.009). Vitamin D was weakly correlated with uACR (r = −0.375; p = 0.000). ADMA was strongly correlated with uACR (r = 0.687; p = 0.00). Multivariate analysis showed an association of ADMA ≥ 0.69 µmol/L (p = 0.000) with albuminuria ≥ 300 mg/g (p = 0.003). Conclusions: ADMA was correlated with the presence of macroalbuminuria, strongly indicating its role in the progression of CKD.

Kidney and Dialysis doi: 10.3390/kidneydial5030041

Authors: Natalia Stepanova Yevheniia Tamazenko

End-stage chronic kidney disease remains a global challenge, with dialysis and transplantation offering only partial or limited solutions. Recent advances in bioengineering have introduced modular strategies that aim to restore kidney function not by replicating the entire organ, but by rebuilding it one segment at a time. Platforms such as kidney organoids, implantable bioartificial kidneys, 3D-bioprinted tissues, and decellularized scaffolds each target specific nephron functions, from filtration to endocrine signaling. This Perspective examines how these technologies can be integrated into interoperable systems that reflect the nephron’s native structure and functional complexity. We assess translational readiness across key benchmarks, including vascular integration, hormonal responsiveness, immune compatibility, and implantability, and discuss the ethical, regulatory, and design considerations that will shape their clinical future. Collectively, these modular strategies offer a pathway toward more personalized, scalable, and physiologically relevant approaches to kidney replacement.

Kidney and Dialysis doi: 10.3390/kidneydial5030040

Authors: Osama El Shamy

New and emerging technologies are being developed to combat some of the most pressing issues regarding peritoneal dialysis training, delivery, and complication identification. Currently used peritoneal dialysis solutions are high-dextrose concentrated acidic solutions that can cause increased glucose absorption and peritoneal membrane degradation via a combination of pseudohypoxia and inflammation. Supply storage, the portability of the currently available devices, and the reactive approach to peritonitis identification and treatment are amongst the challenges facing peritoneal dialysis providers and patients. Technologic advancement to combat these issues are underway, and it is important that we study them comprehensively prior to widespread implementation. In this work, I discuss some of these advancements and technologies.

Kidney and Dialysis doi: 10.3390/kidneydial5030039

Authors: Elin Mitford Davies Morka Ezenwekere Andrew J. Chetwynd Louise Oni Garry McDowell Anirudh Rao

Background: Cardiovascular disease is the leading cause of death in chronic kidney disease populations. The risk of major adverse cardiovascular events (MACE) is greater than that of progression to end-stage kidney disease. An exponential increase in mortality risk is associated with declining kidney function. This study aimed to review the current landscape of traditional and novel blood biomarkers in predicting MACE in ESKD patients. Methods: The systematic review was registered on PROSPERO (CRD42024497403). Standard and extensive Cochrane search methods were used. The latest search date was July 2023. Participants were aged ≥18 years with end-stage kidney disease. Descriptive analysis was performed and data was presented in tabular form. The hazard ratio or odds ratio was presented for potential biomarkers discovered. Results: Overall, 14 studies (4965 participants) were included for analysis; 12 focused on participants requiring haemodialysis and 2 on haemodialysis and peritoneal dialysis. The biomarkers analysed were Troponin I (n = 3), Troponin T (n = 3), B-type natriuretic peptide (n = 2), N-Terminal Pro-Brain-Natriuretic Peptide (n = 7), soluble receptors for advanced glycation end products (n = 2), Galectin 3 (n = 4), and the serum-soluble suppression of tumorigenicity-2 (n = 2). Reported study outcomes included all-cause mortality (n = 11), MACE (n = 5), cardiac specific mortality (n = 6), sudden cardiac death (n = 2), and first cardiovascular event (n = 3). Conclusions: This review outlines the potential role of traditional and novel biomarkers in predicting MACE in end-stage kidney disease. Further larger-scale research is required to establish the validity of the study outcomes to develop new methods of cardiovascular risk prediction in this high-risk population.

Kidney and Dialysis doi: 10.3390/kidneydial5030038

Authors: Vito M. Campese

The practice of medicine needs to be evidence-based [...]

Kidney and Dialysis doi: 10.3390/kidneydial5030037

Authors: Stephanie Y. Ohara Mariana Chavez-Villa Shennen Mao Jacob Clendenon Julie Heimbach Randi Ryan Lavanya Kodali Michelle C. Nguyen Rafael Nateras-Nunez Caroline C. Jadlowiec

Despite improvements in kidney transplantation rates, the shortage of donor kidneys remains a critical issue, exacerbated by non-utilization of recovered kidneys due to quality concerns, necessitating advancements in perfusion methods to enhance graft outcomes and usage. Although static cold storage remains the default standard for kidney preservation, newer methods like hypothermic machine perfusion have shown improved outcomes, including reduced delayed graft function and better survival rates. Hypothermic oxygenated machine perfusion and normothermic machine perfusion offer some potential clinical benefits but studies to date have demonstrated mixed results. In the United States, LifePort and the XVIVO’s Kidney Assist Transport are the most popular hypothermic perfusion devices, with NMP devices mostly in trials. Combining perfusion with biomarkers such as mitochondrial flavin mononucleotide, neutrophil gelatinase-associated lipocalin, and osteopontin shows promise in assessing kidney viability and predicting post-transplant outcomes, though further research is also needed. Emphasis on repair biomarkers, such as uromodulin and osteopontin, aims to better predict graft outcomes and develop new therapies. While notable advancements have been made in the use of machine perfusion and viability testing for liver transplantation, additional research with larger sample sizes is essential to substantiate these results and enhance kidney transplantation outcomes.

Kidney and Dialysis doi: 10.3390/kidneydial5030036

Authors: Danielle E. Fox Robert R. Quinn

The prevalence of early non-infectious peritoneal dialysis (PD) catheter complications makes performing PD challenging for patients and difficult for the healthcare team to manage. Three common patient scenarios are presented: catheter flow dysfunction, peri-catheter leaks, and catheter-related abdominal pain. Practice recommendations are integrated into each scenario and tailored to clinical presentation, patient need, and resource availability. The importance of including patients in the decision-making process is emphasized, and examples of how contextual factors modify the proposed approach to complications are given.

Kidney and Dialysis doi: 10.3390/kidneydial5030035

Authors: Ian Da Silva-Lugo Shuchita Sharma

The prevalence of end-stage renal disease has surged significantly in recent decades, with an 88% increase reported in the United States between 2002 and 2022. Peritoneal dialysis and home hemodialysis offer numerous advantages over in-center hemodialysis, including improved quality of life, increased treatment flexibility, and reduced healthcare costs. Despite strong preferences among healthcare professionals and the documented benefits of home-based therapies, utilization remains limited in the U.S. One of the many factors that play a role in the underutilization of home therapies is inadequate training and perceived incompetence among nephrology fellows in initiating and managing home dialysis patients. Here in this article, we highlight the current educational gaps in home dialysis training and ways to overcome the barriers. There is a need for a multifaceted approach that includes home dialysis rotations and continuity clinics; a dedicated one-year Home Dialysis Fellowship; and continued medical education through didactics, symposiums, and conferences. Here we emphasize the need for structured, longitudinal programs that combine didactic learning with hands-on clinical in fellowship trainings and the importance of dedicated one-year fellowships in cultivating future leaders and experts in the field. By enhancing training pathways and expanding fellowship opportunities, nephrology education can better equip physicians to meet the growing demand for home dialysis, ultimately improving patient outcomes and advancing public health objectives.

Kidney and Dialysis doi: 10.3390/kidneydial5030034

Authors: Kamil Sikora Robert Jan Łuczyk Agnieszka Zwolak Agnieszka Wawryniuk Marta Łuczyk

Background: Stress, anxiety and depression are phenomena that often accompany the onset of chronic illness. The development of psychosomatic medicine has led to the study of the influence of other emotional factors, including the presence of anxiety and depression, on a patient’s health status, in addition to quality of life. The aim of this study is to evaluate the relationship between vascular access function and the occurrence of stress, anxiety and depression in haemodialysis patients. Methods: A total of 202 haemodialysis patients were included in the analysis, and the severity of vascular access problems and levels of negative emotions (feelings of stress, anxiety, depression) were assessed using standardised questionnaires (VAQ, HADS-M, PSS-10). Results: The results show that an increase in vascular access function problems correlated with increased levels of stress (r = 0.262; p < 0.001), anxiety (r = 0.456; p < 0.001) and depression (r = 0.391; p < 0.001). Conclusions: The study confirms the significant impact of vascular access quality on patients’ emotional state, highlighting the need to monitor and optimise its functioning to improve the psychological well-being of dialysis patients.

Kidney and Dialysis doi: 10.3390/kidneydial5030033

Authors: Matteo Righini Martina Titone Davide Martelli Elisabetta Isola Elena Tampieri Romina Graziani Chiara Valentini Matteo De Liberali Antonella Troiano Mattia Monti Vera Minerva Lilio Hu Brunilda Sejdiu Olga Baraldi Andrea Buscaroli

Bloodstream infections are a significant cause of morbidity and mortality among hemodialysis patients. These infections primarily involve Gram-positive bacteria and, less frequently, Gram-negative bacilli. Raoultella ornithinolytica is a Gram-negative bacillus which is known to be a rare opportunistic pathogen. It is found only occasionally in human infections; however, it has been noted as an emerging pathogen. Sepsis caused by this microorganism is very rare. A few cases have been reported among immunocompromised patients or those undergoing invasive procedures. Cases involving urinary catheters or port catheters have also been reported, as well as a single case of a patient on peritoneal dialysis. Here, we present a novel case of Raoultella ornithinolytica bloodstream infection in a patient with chronic renal failure undergoing hemodialysis who was successfully treated. We discuss the microbiology and clinical features of such infections, and consider aspects of treatment.

Kidney and Dialysis doi: 10.3390/kidneydial5030032

Authors: Czarina T. Faldu Daphne H. Knicely

Chronic kidney disease (CKD) remains a significant global health challenge, with its advanced stages necessitating timely and comprehensive patient education, particularly regarding kidney replacement therapy (KRT). Early initiation of education is crucial, as it enhances patient understanding and supports shared decision-making with healthcare teams, ultimately leading to better health outcomes. Evidence demonstrates that CKD education not only increases disease-specific knowledge, but also confers multiple benefits, including reduced healthcare utilization, greater adoption of self-management, delayed KRT initiation, improved survival, higher adherence to therapies, and increased transplant evaluation. Despite these advantages, a disconnect persists between the educational content desired by patients and what is prioritized by healthcare professionals. Structured educational interventions have been shown to improve patients’ ability to make informed decisions about KRT, with studies indicating that after targeted education, the vast majority of patients can articulate their therapy preferences. Furthermore, national and international guidelines highlight the necessity of embedding patient education as a core component of CKD care to empower patients and improve the quality of life. However, challenges remain, including disparities in access, health literacy, and the consistency of educational delivery. There is currently no standardized approach on how to effectively educate CKD patients. This review provides a comprehensive analysis of all aspects of pre-dialysis education and best practices for advanced CKD patient education.

Kidney and Dialysis doi: 10.3390/kidneydial5030031

Authors: Vasiliki Michou

This review synthesizes current evidence on clinical nursing practices in the management of arteriovenous fistulas (AVFs) among patients undergoing hemodialysis (HD). It investigates the identification of risk factors and elements contributing to AVF dysfunction, emphasizing the crucial role of nursing professionals in maintaining, monitoring, and enhancing the long-term functionality of vascular access. The findings indicate that implementing upper limb exercise protocols can significantly support AVF maturation, enhance hemodynamic parameters, and improve vascular access outcomes. Notably, the review highlights the necessity of continuous education for nurses in AVF management, emphasizing their critical role in the successful preservation and optimization of vascular access, including the promotion of exercise interventions. These insights underscore the importance of equipping nursing staff with current knowledge and skills to improve patient outcomes in HD care.

Kidney and Dialysis doi: 10.3390/kidneydial5030030

Authors: Noor Al-deen Shahin Lauren Peccoralo Holly Koncicki Priya Deshpande

Resilience, the ability to adapt and thrive in the face of adversity, is an essential yet under-recognized determinant of outcomes in patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD), particularly those undergoing home-based peritoneal dialysis (PD). While studies have shown that PD can enhance autonomy and quality of life compared to in-center hemodialysis (IHD), it also places substantial emotional, physical and self-management demands on patients. Despite this, resilience is rarely assessed or systematically supported in PD care. This narrative review highlights the importance of resilience in CKD and dialysis populations and extends its application to the unique psychosocial challenges faced by PD patients. This review also introduces psychological frameworks of resilience, in particular the GROW model (Good emotions, Reason and purpose, Others and connections, Wellness flexibility), as tools for clinicians to support PD patients in developing optimism, purpose, strong social networks, and emotional adaptability. We also explore how routine, longitudinal assessment of resilience using validated tools can help improve patient well-being, treatment adherence, and long-term outcomes.

Kidney and Dialysis doi: 10.3390/kidneydial5030029

Authors: Stephen P. Haggerty

Chronic kidney disease (CKD) is prevalent throughout the world, and peritoneal dialysis (PD) has been a growing mode of renal replacement therapy (RRT) for over four decades. Peritoneal dialysis has several advantages in cost, patient satisfaction, and quality of life, despite accounting for only one in ten patients on dialysis in the United States. In spite of some contraindications and barriers to effective PD, the vast majority of renal failure patients are candidates, especially when in a high-volume program with surgical expertise readily available. Reliable access via an intraabdominal PD catheter is paramount for managing end-stage renal disease patients. Surgical approaches for PD catheter insertion have evolved substantially alongside innovations in catheter design. Recent data suggests that the advanced laparoscopic catheter placement offers the best results and long-term survival. However, image-guided fluoroscopic insertion can be performed without general anesthesia, is highly effective, and is growing in usage. Being able to start PD urgently is vital in avoiding hemodialysis (HD) and its complications, and this is a growing theme worldwide, despite slightly higher morbidity. Infectious and mechanical complications are relatively common and are frustrating to PD patients and the physicians who care for them. Peritonitis and exit site infections require antibiotic coverage and sometimes, surgical intervention. Catheter dysfunction is a frequent mechanical issue requiring a multidisciplinary approach: medical treatment, nurse-administered flushing and clot dissolvers, interventional radiology evaluation and wire manipulation, and surgical laparoscopy for catheter salvage.

Kidney and Dialysis doi: 10.3390/kidneydial5030028

Authors: Carlo Garofalo Chiara Ruotolo Christian Nardelli Luigi Di Martino Francesca Cinone Raffaele Prestano Ilaria Fava Concetta Altruda Maria Federica Feliciano Antonio Russo Silvio Borrelli Luca De Nicola Roberto Minutolo

Asymptomatic bacteriuria (ASB) is a very frequent condition in kidney transplant recipients (KTRs). Guidelines advise against screening and treatment of ASB beyond the first month after renal transplantation. Here, we report the case of a 40-year-old female KTR with untreated ASB complicated with allograft pyelonephritis with urosepsis and acute kidney injury. The reported case highlights that ASB remains a grey area in the management of KTRs (after the first month), and there is a need for new ad hoc studies to identify which patients should be screened and eventually treated. Until new findings are available, it is suggested not to treat KTRs with ASB; however, if ASB is detected, stricter monitoring and non-antibiotic prophylaxis are necessary to favor prevention or prompt therapy of severe urinary tract infections.

Kidney and Dialysis doi: 10.3390/kidneydial5030027

Authors: Oluwafisayo Adebiyi Yang Li Kathleen Lane Raza Ahsan Asif Sharfuddin Priya Yenebere Muhammad Y. Jan Muhammad Sohail Yaqub

Background Socioeconomic factors significantly influence access to kidney transplantation, with socially vulnerable populations experiencing delays in receiving transplants, resulting in prolonged dialysis duration and poorer post-transplant outcomes. This study evaluates the relationship between social vulnerability and disparities in preemptive kidney transplantation using the Social Vulnerability Index (SVI), a composite measure developed by the Centers for Disease Control and Prevention (CDC). Methods Utilizing data from the Scientific Registry of Transplant Recipients (SRTR) from 2012 to 2020, we analyzed 155,424 adult kidney transplant recipients. The primary exposure was SVI, categorized into quartiles, while primary outcomes included preemptive transplant status and dialysis vintage. Multivariable regression models were adjusted for clinical covariates such as age, gender, BMI, diabetes, and peripheral vascular disease. Result Findings indicate that higher social vulnerability is significantly associated with a reduced likelihood of preemptive kidney transplantation (p < 0.0001) and an increased duration of dialysis prior to transplantation. Patients in the highest SVI quartile (0.75–1.00) were more than twice as likely to undergo dialysis before transplantation compared to those in the lowest quartile (OR = 2.21, 95% CI: 1.89–2.57). Similarly, increased SVI was strongly correlated with prolonged dialysis duration (OR = 3.43, 95% CI: 3.31–3.55, p < 0.0001). Conclusions These results highlight the impact of socioeconomic disparities on access to timely kidney transplantation. Addressing social vulnerability factors—such as poverty, education, and healthcare access—may help reduce inequities and improve transplantation outcomes. Future interventions should target high-SVI communities to facilitate earlier transplant access and reduce reliance on prolonged dialysis.

Kidney and Dialysis doi: 10.3390/kidneydial5020026

Authors: Jairo N. Fuertes Olivia B. Friedman Michael T. Moore Sofia Rubinstein

This study examined 112 CKD patients’ adherence to and satisfaction with treatment, and their quality of life, as mediated by the level of psychological stress experienced as well as their working alliance, resilience, and social support. The patients were receiving care at a public teaching hospital in the northeast region of the U.S. The results indicated a significant moderate negative correlation between psychological distress and quality of life (r = −0.34, p < 0.01). The results also indicated significant positive moderate to strong correlations between the physician–patient working alliance and adherence (r = 0.42, p < 0.001), satisfaction (r = 0.55, p < 0.001), and quality of life (r = 0.51, p < 0.001), between social support and quality of life (r = 0.39, p < 0.001), and significant moderate positive correlations between resilience and adherence (r = 0.35, p < 0.001) and satisfaction (r = 0.26, p < 0.01). Regression analyses indicated that the following predictors were significant: patient adherence was positively predicted by the working alliance (β = 0.42, p < 0.001); patient satisfaction was positively predicted by the working alliance (β = 0.51, p < 0.001) and negatively predicted by psychological distress (β = −18, p < 0.048); and quality of life was positively predicted by the working alliance (β = 0.38, p < 0.001) and social support (β = 0.28, p < 0.016) and negatively predicted by psychological distress (β = −0.34, p < 0.002). Moderation analyses indicated that the working alliance moderated the relationship between COVID impact and adherence (R2 = 0.27, F(df1, df2) = 8.36, p < 0.001, 95% CI = 0.29–2.74), social support moderated the relationship between COVID impact and adherence (R2 = 0.19, F(df1, df2) = 5.77, p < 0.001, 95% CI = 0.47–2.77), and resilient coping moderated the relationship between COVID impact and satisfaction (R2 = 0.20, F(df1, df2) = 7.89, p < 0.001, 95% CI = 0.94–2.81). The present study provides evidence of the significant role of psychological stressors and social support in influencing CKD patients’ adherence to and satisfaction with treatment, as well as their quality of life.

Kidney and Dialysis doi: 10.3390/kidneydial5020025

Authors: Claudia Torino Giovanni Tripepi Francesca Mallamaci

Chronic diseases are a growing concern in aging populations, with physical inactivity playing a major role in their onset and progression. Chronic kidney disease (CKD), which affects approximately 15% of U.S. adults and over 500 million people worldwide, is strongly associated with sedentary behavior. Despite mounting evidence supporting the benefits of exercise training in CKD management, current treatment approaches remain largely pharmacological, with exercise interventions receiving limited emphasis. One challenge is the uncertainty surrounding the most appropriate exercise modalities for CKD patients, particularly those undergoing dialysis. Recent guidelines from leading nephrology organizations advocate for integrating exercise training into CKD care, recommending at least 150 min of moderate-intensity exercise per week. This narrative review examines clinical studies on exercise interventions in dialysis patients, highlighting their impact on health outcomes and quality of life. Additionally, it explores the physiological mechanisms underlying these benefits and assesses nephrologists’ perspectives on prescribing exercise training. By addressing these critical aspects, this review aims to underscore the necessity of incorporating exercise into CKD treatment strategies.

Kidney and Dialysis doi: 10.3390/kidneydial5020024

Authors: Aniebiot-Abasi Udofia Yiwei Zhang

Background: Infections are a major cause of mortality in haemodialysis patients. The increasing antimicrobial resistance globally further exacerbates this concern. Procalcitonin has shown potential in aiding antimicrobial stewardship and reducing the mortality and morbidity associated with infections. This systematic review aims to synthesise the existing literature on the utility of procalcitonin as a diagnostic and monitoring tool for haemodialysis patients with suspected bacteraemia. Methods: Multiple electronic databases (EMBASE, MEDLINE, and the Cochrane Library) were systematically searched to identify primary studies evaluating procalcitonin use in haemodialysis patients with suspected bacteraemia. Using a narrative synthesis approach, along with other quality assessment tools, recommendations regarding procalcitonin usage in dialysis were formulated. Results: Eleven studies were identified. The review proposes a procalcitonin-guided antibiotic protocol aimed at facilitating antibiotic use in haemodialysis patients with suspected bacteraemia. Caution is, however, advised against relying solely on procalcitonin for diagnosis, emphasising the integration of procalcitonin with other clinical and biomarkers of infection. Conclusions: Procalcitonin shows promise as a valuable diagnostic and monitoring tool for suspected bacteraemia in haemodialysis patients. While caution is advised against relying solely on PCT for diagnosis, its integration with other clinical indicators can enhance infection management. To fully establish its clinical utility, more research is needed.

Kidney and Dialysis doi: 10.3390/kidneydial5020023

Authors: Carlos Perez Tulcanaza André Benítez-Baldassari Andrea Banegas-Sarmiento Jose Daniel Sanchez

Background: Anemia represents a significant complication in patients with advanced chronic kidney disease (CKD) on hemodialysis, primarily caused by reduced renal erythropoietin production. Despite erythropoiesis-stimulating agents (ESAs) being the cornerstone of treatment, hyporesponsiveness to these agents remains a clinical challenge with implications for patient outcomes. Objective: To identify and quantify risk factors associated with hyporesponsiveness to erythropoietin in patients with CKD on hemodialysis who present with anemia. Methods: This multicenter case–control study analyzed data from 784 hemodialysis patients receiving erythropoietin therapy across six dialysis centers in Ecuador between January and December 2019. Hyporesponsiveness was defined as requiring ≥ 200 IU/kg/week of erythropoietin alfa for ≥3 consecutive months to maintain target hemoglobin levels (10–12 g/dL). Demographic, clinical, and laboratory parameters were compared between hyporesponsive cases (n = 123) and responsive controls (n = 661). Bivariate and multivariate logistic regression analyses were performed to identify independent risk factors. Results: The prevalence of erythropoietin hyporesponsiveness was 15.69%. A multivariate analysis identified female sex (adjusted OR = 1.96; 95% CI: 1.20–3.20; p < 0.001), age < 50 years (adjusted OR = 4.25; 95% CI: 2.42–7.47; p < 0.001), serum albumin < 4.0 g/dL (adjusted OR = 10.53; 95% CI: 6.53–16.98; p < 0.001), ferritin ≥ 800 ng/mL (adjusted OR = 7.28; 95% CI: 4.22–12.57; p < 0.001), transferrin saturation < 20% (adjusted OR = 9.27; 95% CI: 5.47–15.69; p < 0.001), parathyroid hormone ≥ 500 pg/mL (adjusted OR = 1.89; 95% CI: 1.16–3.09; p = 0.011), and use of renin–angiotensin system blockers (adjusted OR = 2.25; 95% CI: 1.36–3.71; p = 0.002) as independent risk factors for erythropoietin hyporesponsiveness. Conclusions: Multiple demographic, clinical, and laboratory factors independently contribute to erythropoietin hyporesponsiveness in hemodialysis patients. Identification of these risk factors may guide clinicians in developing individualized treatment approaches, optimizing erythropoietin dosing, and implementing targeted interventions to improve anemia management in this vulnerable population.

Kidney and Dialysis doi: 10.3390/kidneydial5020022

Authors: Karen Fildes Jessica Nealon Karen Charlton Kelly Lambert Anna Lee Debbie Pugh Mikki Smyth Anita Stefoska-Needham

Background: Strategies are needed to address the elevated prevalence of chronic kidney disease (CKD) in socioeconomically disadvantaged regions where obesity, smoking, and type 2 diabetes rates are high. Methods: Recognising the inadequacy of generic health approaches in complex contexts, this study employed a participatory action research (PAR) framework to design and deliver five co-design community workshops in two stages over one year. Stage one workshops identified key matters of concern and stage two focussed on problem solving and co-creating solutions. The goal was to inform health service delivery in a region with high CKD prevalence and explore strategies to overcome barriers to individualised, collaborative care, and promote self-management. Results: The workshops identified three themes: 1. achieving person/family-centred care; 2. multimorbidity and siloed care (stage one); and 3. a kidney wellness framework (stage two). Conclusions: The findings reinforce the need for enhanced care coordination, and highlight the importance of consistent information sources, clear referral pathways, and centralised data sharing among health professionals. The proposed kidney healthcare framework aims to support various professionals, fostering linkages between primary and tertiary care, with an emphasis on professional development, especially in communicating complex information to individuals with multimorbidities. While co-designed healthcare models show promise, challenges persist in effective self-management amidst complex disease information and multimorbidity.