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Chronic Renal Disease: Diagnosis, Treatment, and Management
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Chronic Renal Disease: Diagnosis, Treatment, and Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: 31 October 2025 | Viewed by 766

Special Issue Editor

Dr. Anna Clementi

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Guest Editor
Nephrology and Dialysis Unit, Santa Marta and Santa Venera Hospital, 95024 Acireale, Italy
Interests: acute kidney injury; chronic kidney disease; cardio-renal syndromes
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Chronic kidney disease represents a significant public health issue, affecting >10% of the general population worldwide, amounting to >800 million individuals. It is characterized by a gradual loss of renal function, which can progress to end-stage kidney failure over several months or years. Different diseases are responsible for the development of chronic kidney disease, such as hypertension, diabetes, glomerulonephritis, polycystic kidney disease, recurrent pyelonephritis and prolonged obstruction of the urinary tract. Also, acute kidney injury may be involved, due to maladaptive or incomplete repair mechanisms, resulting in renal fibrosis after an acute event.

The diagnosis of CKD is made by laboratory testing, most often by estimating the glomerular filtration rate through a filtration marker, such as serum creatinine or by testing urine for the presence of albumin or protein (or a combination of these). Importantly, chronic kidney disease has recently emerged as one of the leading causes of mortality, since it is associated with an increased risk of cardiovascular events. The high number of affected individuals and the significant adverse impact of chronic kidney disease should prompt enhanced efforts for early diagnosis, better prevention and treatment.

Dr. Anna Clementi
Guest Editor

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Keywords

  • acute kidney injury
  • chronic kidney disease
  • cardio–renal syndromes
  • clinical nephrology
  • diagnosis and management

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Published Papers (3 papers)

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Research

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14 pages, 777 KiB  
Article
Sex- and Stage-Specific Predictors of Anemia in Chronic Kidney Disease: A Retrospective Cohort Study
by Jui-Ting Chang, Chun-Ji Lin, Jiann-Horng Yeh, Chin-Hung Tsai, I-Shan Hsieh and Po-Ya Chang
J. Clin. Med. 2025, 14(9), 3088; https://doi.org/10.3390/jcm14093088 (registering DOI) - 29 Apr 2025
Abstract
Background: Anemia is a common complication of chronic kidney disease (CKD), yet no study has explored differences in anemia risk factors based on disease severity and gender. Therefore, this study investigates potential differences in anemia risk among individuals with varied kidney disease severities [...] Read more.
Background: Anemia is a common complication of chronic kidney disease (CKD), yet no study has explored differences in anemia risk factors based on disease severity and gender. Therefore, this study investigates potential differences in anemia risk among individuals with varied kidney disease severities and sexes. Methods: This multicenter, longitudinal cohort study was conducted using data (2008–2016) from the Epidemiology and Risk Factors Surveillance of CKD database. This database was associated with Taiwan’s National Health Insurance Research Database (for the 2008–2019 period). To identify predictive risk factors for anemia, we developed a subset multivariate logistic model using stepwise variable selection. Additionally, 10-fold cross-validation was conducted to facilitate model selection and internal validation. Results: Of the 5656 patients with CKD, 519 (9.18%) with anemia and 5137 (90.82%) without. After adjusting for age, sex, and serum creatinine, stepwise logistic regression analysis identified the main independent predictive factors for anemia in CKD patients. Notably, “Receive low sodium diet education” (OR: 0.66, 95% CI: 0.446–0.975), “DBP (mmHg)” (OR: 0.98, 95% CI: 0.965–0.999), “Gout” (OR: 1.86, 95% CI: 1.175–2.937), and “Congestive heart failure” (OR: 1.85, 95% CI: 1.131–3.028) was significantly associated with the presence of anemia among CKD patients. Conclusions: This study identifies gout and cardiovascular disease as important correlates of anemia in patients with CKD. Moreover, it reveals an inverse association between elevated diastolic blood pressure and receiving education on a low-sodium diet with the occurrence of anemia. Full article
(This article belongs to the Special Issue Chronic Renal Disease: Diagnosis, Treatment, and Management)
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12 pages, 226 KiB  
Article
Spirit Interim Analysis: A Multicenter Prospective Observational Study of Outpatients with CKD and Decreased eGFR to Assess Therapeutic Algorithms, Disease Management and Quality of Life in Greece
by Dimitrios Petras, Smaragdi Marinaki, Stylianos Panagoutsos, Ioannis Stefanidis, Kostantinos Stylianou, Evangelia Ntounousi, Sofia Lionaki, Ioannis Tzanakis, Ioannis Griveas, Dimitrios Xidakis, Eleni Theodoropoulou, Dimitris Gourlis, Argyris Andreadellis, Dimitrios Goumenos and Vassilios Liakopoulos
J. Clin. Med. 2025, 14(6), 2079; https://doi.org/10.3390/jcm14062079 - 18 Mar 2025
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Abstract
Background: Chronic Kidney Disease (CKD) affects 8–16% of the population worldwide and is characterized by an estimated Glomerular Filtration Rate (eGFR) of less than 60 mL/min/1.73 m2 for more than 3 months. The main purpose of the study is to record the [...] Read more.
Background: Chronic Kidney Disease (CKD) affects 8–16% of the population worldwide and is characterized by an estimated Glomerular Filtration Rate (eGFR) of less than 60 mL/min/1.73 m2 for more than 3 months. The main purpose of the study is to record the treatment algorithms and disease management of patients presenting for the first time to hospital-based nephrologists with a reduced eGFR and CKD diagnosis, under real-world clinical practice in Greece. Methods: This is the 6-month interim analysis of an ongoing, multicenter, observational, prospective, national study, which included 178 patients, with an eGFR between <60 and 15 mL/min/1.73 m2, presenting for the first time to nephrologists at 15 public hospital units. Results: The median age of the patients was 71 years old, with 39.6% of them categorized as CKD stage G3b. Of these patients, 71.6% and 33.7% suffered from arterial hypertension and type 2 diabetes mellitus, respectively; 78.7% of patients received antihypertensive and 38.5% antidiabetic medications. Calcium channel blocker usage increased with disease progression (from 52.2% at G3a, to 67.9% and 67.6% at G3b and G4, respectively), while that of angiotensin II receptor antagonists decreased (from 78.3% at G3a, to 41.5% and 17.6% at G3b and G4, respectively). A decrease in metformin usage and an increase in Dipeptidyl peptidase-4 inhibitor (DPP4i) usage was also observed upon disease progression. Furthermore, 18.5%, 32.0% and 7.7% of patients received Sodium-glucose cotransporter-2 inhibitors (SGLT2i) at the G3a, G3b and G4 stages, respectively. Conclusions: The interim analysis results contributed to the collection of real-world data for the therapeutic patterns and the management of CKD in Greece. Full article
(This article belongs to the Special Issue Chronic Renal Disease: Diagnosis, Treatment, and Management)

Review

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24 pages, 966 KiB  
Review
High-Volume Hemodiafiltration Versus High-Flux Hemodialysis: A Narrative Review for the Clinician
by Bernard Canaud, Giovanni Strippoli and Andrew Davenport
J. Clin. Med. 2025, 14(8), 2614; https://doi.org/10.3390/jcm14082614 - 10 Apr 2025
Viewed by 386
Abstract
Background: End-stage kidney disease (ESKD) management presents a significant challenge, with increasing patient burden, escalating costs, and unmet needs in improving survival and quality of life. High-volume hemodiafiltration has been found to offer enhanced solute clearance, improved inflammatory marker profiles, and better patient-centered [...] Read more.
Background: End-stage kidney disease (ESKD) management presents a significant challenge, with increasing patient burden, escalating costs, and unmet needs in improving survival and quality of life. High-volume hemodiafiltration has been found to offer enhanced solute clearance, improved inflammatory marker profiles, and better patient-centered outcomes in multiple trials compared with high-flux hemodialysis. Recent data also confirm a survival advantage compared to standard high-flux hemodialysis. Methods: We compiled a narrative review for the clinician illustrating evidence supporting the comparative performance of high-volume hemodiafiltration with conventional high-flux hemodialysis in ESKD management. Data on intermediary outcomes including biochemical and clinical benefits, as well as patient-centered outcomes and all-cause and cardiovascular death data from prospective randomized trials, their meta-analyses, and real-world cohort studies were reviewed and summarized. Results: Randomized studies in adults have found that high-volume hemodiafiltration demonstrates superior outcomes, with a 23% improvement in survival rates when achieving convective volumes ≥23 L/session, enhanced removal of uremic toxins, reduced inflammation, and better patient-reported outcomes. Cohort studies in pediatric populations find associations with improvements in growth, cognitive development, and cardiovascular health. Hemodiafiltration appears to be cost-effective when accounting for extended life expectancy and improved quality of life, although the existing data are limited to European geographies. Conclusions: Hemodiafiltration offers enhanced survival, a reduced treatment burden, and improved quality of life for ESKD patients. Given the existing data of superiority versus high-flux hemodialysis, it is plausible that hemodiafiltration will become the standard of care. Full article
(This article belongs to the Special Issue Chronic Renal Disease: Diagnosis, Treatment, and Management)
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