Kidney Dial., Volume 6, Issue 3 (September 2026) – 20 articles

Background: Pruritus is a frequently encountered problem in patients undergoing hemodialysis and may negatively affect sleep quality. Therefore, this study aims to examine the relationship between pruritus and sleep quality in patients undergoing hemodialysis. Methods: Descriptive, cross-sectional study. Between June and December 2025, 150 patients receiving treatment at dialysis centers in Istanbul who met the inclusion and exclusion criteria were included. The data were collected through face-to-face interviews using an information form to determine the patients’ sociodemographic and disease-related characteristics, the 5-D Itch Scale, and the Pittsburgh Sleep Quality Index (PSQI). Results: A positive association was found between the total pruritus score and several dimensions of sleep quality, including subjective sleep quality, sleep latency, sleep duration, sleep disturbances, and daytime dysfunction (p < 0.05). Higher scores for the impact of pruritus on daily life (disability), duration, course, and severity of pruritus were associated with poorer sleep quality. In the multiple regression analysis, gender, income level, duration of diagnosis, smoking status, and pruritus severity were significantly associated with PSQI scores. The model explained 38.3% of the variance in PSQI scores. Conclusions: Pruritus severity was significantly associated with poorer sleep quality and greater impairment in daily life. Sociodemographic characteristics were also associated with sleep quality. Therefore, a comprehensive, multidimensional assessment of patients may be important in managing pruritus and sleep disturbances. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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 $\ge$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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article