Submit to Special Issue Submit Abstract to Special Issue Review for Biomedicines Propose a Special Issue

Journal Menu

Journal Browser

New Advances in Chronic Kidney Disease: Biology, Diagnosis and Therapy (3rd Edition)

Editors
Special Issue Information
Keywords
Benefits of Publishing in a Special Issue
Published Papers

A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Cell Biology and Pathology".

Deadline for manuscript submissions: 30 September 2026 | Viewed by 10085

Share This Special Issue

Editors

Dr. Susana Coimbra

E-Mail Website
Guest Editor

1. UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
2. Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculdade de Farmácia da Universidade do Porto, Porto, Portugal
3. TOXRUN—Toxicology Research Unit, University Institute of Health Sciences, Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), CRL, 4585-116 Gandra, Portugal
Interests: biomarkers; chronic kidney disease; inflammation; cardiovascular disease risk factors
Special Issues, Collections and Topics in MDPI journals

Dr. Alice Santos-Silva

E-Mail Website
Guest Editor

UCIBIO i4HB, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
Interests: anemia; erythrocyte membrane disturbances; hereditary spherocytosis; chronic kidney disease; renal anemia; hemodialysis; inflammatory diseases
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Chronic kidney disease (CKD) is characterized by the progressive and usually irreversible deterioration of renal function. The worsening of CKD is associated with a high comorbidity burden, and among patients receiving dialysis treatment for end-stage kidney disease (ESKD), the mortality rate is 10- to 20-fold higher than that in the general population. ESKD patients commonly present with chronic inflammation, protein–energy malnutrition, and progressive cardiovascular disease (CVD), which is the most common cause of mortality. Inflammation can be a trigger and/or a consequence of CKD; it may result from the primary cause of CKD, such as diabetes or hypertension, and may be exacerbated by renal dysfunction-related changes (e.g., uremia, oxidative stress, metabolic acidosis).

Ensuring a better understanding of the uremic milieu of CKD pathophysiology and its relationship with its comorbidities is the main focus of this Special Issue. The identification of biomarkers, or panels of biomarkers, of cardiorenal syndrome and early kidney injury will help clinicians when making therapeutic decisions, enabling them to choose more adequate therapeutic strategies earlier on in order to prevent or minimize CKD progression. The investigation of novel therapeutic approaches should also be encouraged.

Dr. Susana Coimbra
Dr. Alice Santos-Silva
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Biomedicines is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

inflammation
kidney biomarkers
kidney injury
chronic kidney disease
dialysis
cardiorenal syndrome risk
CKD anemia
kidney physiopathology
CKD treatment

Benefits of Publishing in a Special Issue

Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
Reprint: MDPI Books provides the opportunity to republish successful Special Issues in book format, both online and in print.

Further information on MDPI's Special Issue policies can be found here.

Published Papers (8 papers)

Download All Papers

Order results

Result details

Show export options Show export options

Select all

Export citation of selected articles as:

Research

Jump to: Review, Other

23 pages, 5009 KB

Open AccessArticle

Toward Explainable Precision Nephrology: Machine Learning-Based Chronic Kidney Disease Prediction

by Moiz Qureshi, Akm Azad, Hasnain Iftikhar and Paulo Canas Rodrigues

Biomedicines 2026, 14(7), 1459; https://doi.org/10.3390/biomedicines14071459 - 27 Jun 2026

Viewed by 453

Abstract

Background/Objectives: Chronic kidney disease (CKD) is an incurable and progressive condition; if diagnosed at an early stage, it would significantly reduce the risk of complications and enhance the outcomes for the patient. Methods: In this study, a custom dataset of 380 instances and 20 clinical attributes was used to develop and evaluate the machine learning (ML) models for reliable CKD prediction and to enhance the interpretability using explainable artificial intelligence (XAI) techniques. Artificial neural networks, C5.0, CHAID, logistic regression, linear support vector machines (L1 and L2 regularization), k-nearest neighbors (KNN), random tree, and deep neural networks were implemented. Correlation-based methods, recursive feature elimination, and LASSO were used for feature selection. SMOTE and SMOTETomek resampling techniques were used to address class imbalance. Three experimental set-ups were considered: (i) using SMOTETomek, (ii) with and without SMOTE, and (iii) grouped features according to the strength of correlation (high, moderate, low). Accuracy, precision, recall, F1 Score, AUC, and Gini index were used to evaluate the model’s performance. The pipeline was implemented in Python using the scikit-learn and imbalanced-learn packages. Results: Using SHAP and LIME, model interpretability was improved, with the KNN classifier obtaining the highest accuracy of 94.74% without SMOTE, and the C5.0 model obtained the highest accuracy of 92.98% with SMOTE. In the feature-group experiments, the L1-regularized linear SVM achieved high accuracy (89.47%) with highly correlated features. In general, both resampling methods improved model robustness, and feature selection methods reduced the model’s dimensionality with little loss in performance. Conclusions: The ML framework proposed is promising in predicting CKD with high accuracy and interpretability with relevance. By combining feature selection with class balancing and explainable AI, the model’s performance improves, and its clinical trustworthiness is enhanced. The results indicate the potential in using ML-based decision support systems for early-stage CKD diagnosis and personalized healthcare. Full article

(This article belongs to the Special Issue New Advances in Chronic Kidney Disease: Biology, Diagnosis and Therapy (3rd Edition))

► Show Figures

Figure 1

10 pages, 464 KB

Open AccessArticle

Excessive Ultrafiltration Associates with EPO Hyporesponsiveness in Elderly Chronic Hemodialysis Patients

by Luís Belo, Maria João Valente, Susana Rocha, Susana Coimbra, Cristina Catarino, Elsa Bronze-da-Rocha, Petronila Rocha-Pereira, Maria do Sameiro-Faria, José Gerardo Oliveira, João Carlos Fernandes, Vasco Miranda and Alice Santos-Silva

Biomedicines 2026, 14(3), 497; https://doi.org/10.3390/biomedicines14030497 - 25 Feb 2026

Viewed by 782

Abstract

Background: The population of elderly patients undergoing chronic hemodialysis is increasing, and anemia represents a frequent complication. The aim of our study was to evaluate the association between ultrafiltration rate (UFR) in hemodialysis and erythropoietin (EPO) response in elderly patients with end-stage kidney disease (ESKD). Methods: This was a multicenter, retrospective observational study, involving elderly patients (aged 65 years or more) under chronic hemodialysis therapy. Individuals were divided into two groups according to the UFR adjusted to weight (UFR/W): lower (UFR-N) or higher (UFR-H) than 10 mL/h/kg. EPO resistance index (ERI) was calculated. We evaluated the hemogram, reticulocyte count, and quantified markers of iron metabolism and inflammation. Results: A total of 193 patients were enrolled in the study: 141 patients met criteria for inclusion in UFR-N group and 52 in UFR-H group. Compared to UFR-N, patients in the UFR-H group presented significantly higher doses of erythropoiesis-stimulating agents (ESA) and ERI values, with similar hemoglobin (Hb) and inflammatory markers levels. In a sub-analysis, within patients presenting transferrin saturation (TSAT) lower than 20%, a more marked difference in ERI between UFR groups was observed, being much higher in UFR-H compared with UFR-N. In this subgroup (UFR-H with lower TSAT), levels of hepcidin were lower than in the other subgroups. Conclusions: Our data show that UFR appears to be a contributing factor of ESA response in elderly patients under hemodialysis, particularly in those with lower iron availability. These findings suggest that inadequate weight control and/or UF prescription seem to aggravate ESA needs to achieve target Hb. Full article

(This article belongs to the Special Issue New Advances in Chronic Kidney Disease: Biology, Diagnosis and Therapy (3rd Edition))

► Show Figures

Figure 1

19 pages, 1340 KB

Open AccessArticle

Prognostic Significance of Lactate Dehydrogenase-to-Albumin Ratio and Neutrophil Percentage-to-Albumin Ratio in IgA Nephropathy

by Balázs Sági, Tibor Vas, Sadra Salehi and Tibor József Kovács

Biomedicines 2026, 14(2), 318; https://doi.org/10.3390/biomedicines14020318 - 30 Jan 2026

Viewed by 787

Abstract

Background: Inflammation plays a key role in the development of immunoglobulin A nephropathy (IgAN). The lactate dehydrogenase-to-albumin ratio (LAR) and neutrophil percentage-to-albumin ratio (NPAR) have emerged as markers reflecting inflammation and nutritional status. This study evaluated the prognostic significance of LAR and NPAR for predicting renal and cardiovascular (CV) outcomes in patients with IgAN. Methods: This study included 121 patients with biopsy-proven IgAN. The mean age was 43.6 ± 12.9 years, and 66% were male. Average follow-up time was 98.7 ± 63.3 months. The primary composite endpoints were total mortality, major CV events, and end-stage renal disease. Secondary endpoints, cardiovascular, or renal endpoints were also examined separately. Cox proportional hazards analyses were performed to evaluate these markers in predicting renal and CV prognosis. Results: Patients were divided into high and low groups for both LAR and NPAR based on ROC curve analysis. High LAR was linked to poorer outcomes for the primary composite endpoint (p = 0.03) and for separate renal (p = 0.018) and cardiovascular (p = 0.009) endpoints. Similarly, high NPAR was associated with worse primary (p = 0.02), renal (p = 0.039), and CV (p = 0.042) outcomes. In multivariate Cox regression analysis, high LAR remained an independent risk factor for the primary composite endpoint (HR = 4.165, 95% CI = 1.45–11.959, and p = 0.008) but not for renal or CV endpoints individually. Conclusions: High LAR and NPAR, as markers of inflammation and altered nutritional status, are associated with poorer renal and cardiovascular outcomes in IgAN and may serve as useful prognostic indicators. Full article

(This article belongs to the Special Issue New Advances in Chronic Kidney Disease: Biology, Diagnosis and Therapy (3rd Edition))

► Show Figures

Figure 1

16 pages, 1133 KB

Open AccessArticle

The Interplay of Cardiovascular Comorbidities and Anticoagulation Therapy in ESRD Patients on Haemodialysis—The South-Eastern Romanian Experience

by Ioana Livia Suliman, Florin Gabriel Panculescu, Bogdan Cimpineanu, Stere Popescu, Dragos Fasie, Georgeta Camelia Cozaru, Nelisa Gafar, Liliana-Ana Tuta and Andreea Alexandru

Biomedicines 2025, 13(10), 2387; https://doi.org/10.3390/biomedicines13102387 - 29 Sep 2025

Cited by 5 | Viewed by 1323

Abstract

Background: End-stage renal disease (ESRD) patients on haemodialysis present a high burden of cardiovascular comorbidities and require anticoagulation, which increases bleeding risk. Methods: We performed a retrospective observational study (2021–2024) in the Haemodialysis Centre of The Clinical Emergency Hospital of Constanta County, Romania, including 50 adults with stage G5 CKD on haemodialysis for ≥3 months and receiving anticoagulant therapy. We collected from electronic medical records detailed demographic data (age, sex, place of residence), comorbidities (hypertension, atrial fibrillation, ischaemic heart disease, diabetes, deep-vein thrombosis, stroke, myocardial infarction, pulmonary embolism, cirrhosis), lifestyle factors (smoking and alcohol consumption), vascular access type (arteriovenous fistula or central venous catheter) and laboratory parameters (haemoglobin, haematocrit, creatinine, albumin, total protein, electrolytes, LDL- and HDL-cholesterol, total cholesterol, INR, APTT, D-dimer, BNP, CK-MB, troponin). All laboratory units were standardised and checked for plausibility. Results: Median age was 71 years; 48% were female. The most common comorbidities were: hypertension (100%), atrial fibrillation (100%) and ischaemic heart disease (62–81%). Patients exhibited severe anaemia (mean Hb ~9.7 g/dL), nephrotic-range proteinuria, hypoalbuminaemia, and impaired coagulation profiles (INR ~1.8–1.9; prolonged APTT in men). Female patients had higher platelet counts and D-dimer levels, suggesting a stronger prothrombotic profile, while males showed longer APTT. Cardiovascular strain was reflected by elevated BNP in men and also troponin/CK-MB. Correlations included smoking with leukocytosis, alcohol with increased urine density, diabetes with higher urea and lower protein, and subtherapeutic INR in cerebrovascular disease. Conclusions: Patients with ESRD on haemodialysis and anticoagulant therapy display a complex interplay of cardiovascular comorbidities, anemia, overlapping thrombotic and bleeding risks, with sex-specific differences. Therefore, systematic monitoring of proteinuria, haemoglobin, D-dimer, and coagulation markers is crucial to balance thrombotic and bleeding risks. Objective: To characterise the clinical and paraclinical profile and comorbidity–laboratory correlations of ESRD patients undergoing haemodialysis and anticoagulant therapy. Full article

(This article belongs to the Special Issue New Advances in Chronic Kidney Disease: Biology, Diagnosis and Therapy (3rd Edition))

► Show Figures

Figure 1

Review

Jump to: Research, Other

27 pages, 632 KB

Open AccessReview

Renal Functional Reserve–Informed Personalized Renoprotection in Chronic Kidney Disease: A Proposed Extension of the KDIGO CGA Framework

by Dmytro D. Ivanov, Anatoliy I. Gozhenko, Volodymyr V. Bezruk and Mariia D. Ivanova

Biomedicines 2026, 14(7), 1478; https://doi.org/10.3390/biomedicines14071478 - 29 Jun 2026

Viewed by 414

Abstract

The Kidney Disease: Improving Global Outcomes (KDIGO) CGA framework remains the essential basis for chronic kidney disease (CKD) classification, risk stratification, and guideline-based therapy. However, eGFR and albuminuria do not always explain the physiological mechanism maintaining the current filtration level or the heterogeneity of treatment responses. This narrative review proposes a hypothesis-generating functional–hemodynamic extension of KDIGO CGA that incorporates renal functional reserve (RFR), blood pressure, volume status, proteinuria phenotype, and selected tubular markers. RFR is discussed as a dynamic stress test of nephron reserve rather than as a replacement for eGFR or albuminuria. A low, zero, or negative RFR may suggest reserve exhaustion or relative hyperfiltration, but its interpretation depends on standardized testing conditions and clinical context. We distinguish established evidence-based therapy—RAAS blockade in albuminuric or hypertensive CKD, SGLT2 inhibition for kidney and cardiorenal protection, and non-steroidal MRA therapy in selected patients—from conceptual sequencing hypotheses such as RAASi-prioritized, SGLT2i-prioritized, early dual, or staged triple renoprotection. The review also summarizes albuminuria as a two-compartment phenomenon involving both glomerular passage and proximal tubular handling of filtered proteins. The proposed framework is not a validated treatment algorithm. It is intended to support physiological phenotyping, interpretation of early eGFR changes, and the design of prospective studies that test whether RFR adds independent prognostic or therapeutic value beyond KDIGO CGA. Full article

(This article belongs to the Special Issue New Advances in Chronic Kidney Disease: Biology, Diagnosis and Therapy (3rd Edition))

► Show Figures

Figure 1

36 pages, 2289 KB

Open AccessReview

Resolving Inflammation in CKD: The Potential of SPMs and Omega-3 Derivatives as Biomarkers and Therapeutics

by Beata Franczyk, Wiktoria Lisińska, Katarzyna Hossa, Kinga Katańska, Anna Wieczorek, Aleksandra Prusak, Zuzanna Biegała, Jacek Rysz and Ewelina Młynarska

Biomedicines 2026, 14(3), 619; https://doi.org/10.3390/biomedicines14030619 - 10 Mar 2026

Cited by 1 | Viewed by 1520

Abstract

Chronic kidney disease (CKD) affects more than 10% of the population and is associated with a persistent, low-grade inflammatory state that accelerates tubulointerstitial fibrosis, worsens prognosis, and increases cardiovascular risk. This review aims to synthesize current knowledge on specialized pro-resolving mediators (SPMs) in the context of CKD pathophysiology, biomarkers, and therapeutic potential. We discuss key anti-inflammatory and pro-resolving mechanisms of SPMs that translate into nephroprotective and antifibrotic effects in experimental kidney models. The review summarizes data on EPA/DHA supplementation, including its impact on lipid profiles, inflammatory biomarkers (CRP, IL-6, TNF-α), and oxidative stress in patients with CKD. We also highlight contemporary analytical methods for biomarker assessment (LC-MS/MS, UHPLC-HRMS) and their potential for monitoring inflammatory activity across its phases (initiation, attenuation, resolution), CKD progression, and responses to ω-3/SPM-based interventions. Finally, we discuss the therapeutic potential of SPMs, as well as safety considerations and pharmacological interactions. In conclusion, SPMs and ω-3-derived mediators represent promising research and clinical targets as markers and modulators of inflammation in CKD, but require further validation in well-designed prospective studies. Full article

(This article belongs to the Special Issue New Advances in Chronic Kidney Disease: Biology, Diagnosis and Therapy (3rd Edition))

► Show Figures

Figure 1

19 pages, 1266 KB

Open AccessReview

Reporting of Perirenal Hematoma Size After Ultrasound-Guided Renal Biopsy in Adults: A Scoping Review

by Piotr Białek, Weronika Banasik, Adam Dobek, Michał Żuberek, Krzysztof Falenta, Ilona Kurnatowska and Ludomir Stefańczyk

Biomedicines 2025, 13(12), 2943; https://doi.org/10.3390/biomedicines13122943 - 29 Nov 2025

Cited by 2 | Viewed by 2408

Abstract

Introduction: Percutaneous renal biopsy (PRB) is the gold standard for diagnosing nephropathies, but it carries a risk of bleeding complications, mainly perinephric hematomas (PHs). While PH incidence is often reported, the significance of PH size remains insufficiently explored. This scoping review systematically mapped the evidence on PH size after ultrasound-guided PRB in adults, focusing on imaging modalities, measurement methods, the definition of ‘large’ PH, factors influencing PH size, and its clinical implications. Materials and Methods: Following the Joanna Briggs Institute methodology, we searched PubMed/MEDLINE, Embase, Cochrane CENTRAL, and Scopus through 27 August 2025. Eligible studies included at least 50 adult subjects undergoing ultrasound-guided PRB with quantitative, imaging-based assessment of PH size. Results: Fifty-one studies met the inclusion criteria. Almost all relied on ultrasound, with only one using computed tomography. PH size was measured using heterogeneous methods, most often one-dimensional diameters, less frequently surface area or volumetry, with no standardization. Reported PH frequencies varied substantially across studies (1.1–85%), likely reflecting differences in imaging protocols, timing, and reporting thresholds. Several studies proposed PH size thresholds (e.g., diameter ≥ 2–3 cm, volume ≥ 40–85 mL) linked to adverse outcomes such as transfusion or hemodynamic instability. Factors associated with larger PHs included needle gauge, number of passes, impaired kidney function, coagulopathy, and certain histopathologies. Conclusions: PH size has prognostic value beyond incidence alone. Standardized measurement and reporting are needed to clarify its clinical relevance after PRB. Full article

(This article belongs to the Special Issue New Advances in Chronic Kidney Disease: Biology, Diagnosis and Therapy (3rd Edition))

► Show Figures

Figure 1

Other

Jump to: Research, Review

27 pages, 1188 KB

Open AccessSystematic Review

Impact of Serum Phosphate, Potassium and Other Electrolyte Levels on Sudden Cardiac Death and Cardiovascular Mortality in Haemodialysis and Peritoneal Dialysis: A Systematic Review and Meta-Analysis

by Beata Franczyk, Jacek Rysz and Anna Gluba-Sagr

Biomedicines 2026, 14(3), 605; https://doi.org/10.3390/biomedicines14030605 - 9 Mar 2026

Cited by 1 | Viewed by 1336

Abstract

Background: Dialysis patients have a very high burden of cardiovascular mortality, yet the contribution of specific serum electrolytes to sudden cardiac death (SCD) and cardiovascular death across haemodialysis (HD) and peritoneal dialysis (PD) remains uncertain. Methods: We conducted a PROSPERO-registered systematic review and meta-analysis (2010–2025) of cohort studies reporting adjusted hazard ratios (HRs) for the association between baseline or time-averaged serum electrolytes and cardiovascular mortality or SCD in adult maintenance HD and/or PD. Random-effects models with modality-specific and pooled analyses were applied. Results: Thirty-five cohorts (over 200,000 patients) met inclusion criteria. Across modalities, categorical analyses showed that high phosphate and low magnesium were consistently associated with approximately 2-fold higher cardiovascular mortality, while extreme potassium categories conferred similar excess risk, driven largely by PD. In HD, hypomagnesaemia and hyperphosphataemia were each associated with around 2-fold higher risk, and lower continuous sodium levels were linearly related to higher cardiovascular mortality. In PD, severe potassium abnormalities, hypomagnesaemia and high phosphate categories were strongly associated with cardiovascular death, and a lower Na/Cl ratio identified patients at particularly high risk. Heterogeneity was generally modest for categorical magnesium and phosphate, but substantial for some potassium and continuous-exposure models. Sensitivity analyses confirmed the robustness of key findings. Conclusions: Across HD and PD, abnormalities in phosphate, magnesium, potassium and sodium are strong and largely consistent markers of cardiovascular mortality, and likely SCD, with important modality-specific patterns. These data support intensified, modality-tailored management of electrolyte profiles as a central component of cardiovascular and SCD risk reduction in dialysis. Full article

(This article belongs to the Special Issue New Advances in Chronic Kidney Disease: Biology, Diagnosis and Therapy (3rd Edition))

► Show Figures

Journal Menu

Journal Browser

New Advances in Chronic Kidney Disease: Biology, Diagnosis and Therapy (3rd Edition)

Share This Special Issue

Editors

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (8 papers)

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI