Kidney Dial., Volume 6, Issue 1 (March 2026) – 17 articles

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article