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Clinical Epidemiology in Chronic Kidney Disease
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Clinical Epidemiology in Chronic Kidney Disease

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

Deadline for manuscript submissions: 30 June 2025 | Viewed by 4560

Special Issue Editors

Dr. Vincenzo Antonio Panuccio

E-Mail Website
Guest Editor
GOM “Bianchi-Melacrino-Morelli”, Via Vallone Petrara SNC, 89124 Reggio Calabria, Italy
Interests: hemodialysis; peritoneal dialysis; dialysis; hypertension; renal disease; clinical nephrology; chronic renal failure; acute kidney injury; kidney transplantation; renal biopsy
Special Issues, Collections and Topics in MDPI journals
Dr. Claudia Torino

E-Mail Website
Guest Editor
Institute of Clinical Physiology, National Research Council, 89124 Reggio Calabria, Italy
Interests: epidemiology; ESRD; clinical studies; clinical trials; cardiovascular

Special Issue Information

Dear Colleagues,

Chronic kidney disease (CKD) is one of the major health problems worldwide, with an estimated prevalence of stages 1–4 of 16% in Europe and 13% in the US. Patients with end-stage kidney disease (ESKD) have an incredibly high risk of death and cardiovascular disease that is difficult to predict with Framingham risk factors.

Also, the high burden of comorbidities in this population of patients, including hypertension, diabetes, mineral bone disease, vascular calcification, endothelial dysfunction, coagulation abnormalities, accumulation of uremic toxins, increased oxidative and metabolic stress and inflammation, has an important impact on social and healthcare costs.

This Special Issue aims to collect original articles focused on the epidemiology of comorbidities, cardiovascular events, mineral bone disorders and other complications that can occur in chronic kidney disease patients.

We would like to pay special attention to novel therapies that impact various aspects of renal disease.

We invite researchers to contribute original articles or review articles about epidemiology of comorbidities or CV diseases and new therapies in CKD.

Potential topics include but are not limited to the following:

  • Epidemiology of the onset and progression of CKD and/or ESRD;
  • Epidemiology of cardiovascular complications in CKD and/or ESRD;
  • Epidemiology of mineral bone disease in CKD and/or ESRD;
  • Mechanisms shared between kidneys and other organs and/or diseases;
  • New therapeutic strategies;
  • Novel approaches in the epidemiology of comorbidities in CKD patients thanks to the use of Artificial Intelligence.

Dr. Vincenzo Antonio Panuccio
Dr. Claudia Torino
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 100 words) can be sent to the Editorial Office for announcement on this website.

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-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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

  • chronic kidney disease
  • end-stage kidney disease
  • dialysis
  • hypertension
  • renal disease
  • clinical nephrology
  • chronic renal failure

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Published Papers (5 papers)

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Research

10 pages, 1176 KiB  
Article
Post-Dialysis Fatigue Is Not Associated with Serum Lactate Levels in Patients on Chronic Hemodialysis
by Maurizio Bossola, Nunzia Ciferri, Ilaria Mariani, Tania Monteburini, Stefano Santarelli and Enrico Di Stasio
J. Clin. Med. 2025, 14(8), 2706; https://doi.org/10.3390/jcm14082706 - 15 Apr 2025
Viewed by 188
Abstract
Background/Objectives: To measure the peri-dialytic serum lactate, sodium, potassium, calcium, and pH and base excess in chronic hemodialysis patients with and without post-dialysis fatigue (PDF). Methods: Patients were asked “Do you feel fatigued after dialysis?” Each patient was invited to rate the [...] Read more.
Background/Objectives: To measure the peri-dialytic serum lactate, sodium, potassium, calcium, and pH and base excess in chronic hemodialysis patients with and without post-dialysis fatigue (PDF). Methods: Patients were asked “Do you feel fatigued after dialysis?” Each patient was invited to rate the intensity, duration, and frequency of PDF from one to five. The recovery time after the hemodialysis session (TIRD) was calculated, and inviting patients were to answer the following single open-ended question: “How long does it take you to recover from a dialysis session?” Pre- and post-dialysis arterial blood was sampled, and pH, bicarbonates, base excess, sodium, calcium, potassium, and lactate were measured. Results: One hundred fifty-eight patients were included in the study. One hundred seventeen patients declared to suffer from PDF and forty-one did not. Median [range] PDF frequency, intensity, duration, and TIRD were 5 (1–5), 4 (1–5), 3 (1–5), and 12 h (1–48), respectively. Seventy patients had a TIRD ≤ 12 h and forty-seven had a TIRD > 12 h. Median post-dialysis and post-dialysis/pre-dialysis difference serum lactate levels (mmol/L) did not differ between patients with and without PDF (p = 0.111 and p = 0.395, respectively). In addition, the distribution of patients according to post-dialysis serum lactate levels was similar in the presence or absence of PDF. The median post-dialysis and post-dialysis/pre-dialysis difference serum lactate concentrations did not differ significantly according to the score of the PDF intensity and PDF duration (p = 0.928 and 0.935, p = 0.610 and 0.548, respectively). Finally, we stratified patients into two groups according to the length of TIRD: ≤12 h and >12 h. The median post-dialysis serum lactate concentrations did not differ significantly between the two groups (p = 0.862) as well as the median post-dialysis/pre-dialysis difference (p = 0.583). Also, the distribution of patients according to post-dialysis serum lactate levels was similar in the two groups. Conclusions: PDF and TIRD are not associated with peri-dialytic changes in serum lactate in patients on chronic hemodialysis. Full article
(This article belongs to the Special Issue Clinical Epidemiology in Chronic Kidney Disease)
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13 pages, 2005 KiB  
Article
Pediatric Chronic Kidney Disease During Pandemic Conditions—A Single-Center Experience
by Łukasz Biesiadecki, Joanna Jacuńska, Paulina Tomecka, Aleksandra Bruciak and Kinga Musiał
J. Clin. Med. 2025, 14(5), 1608; https://doi.org/10.3390/jcm14051608 - 27 Feb 2025
Viewed by 432
Abstract
Background/Objectives: The prevalence of chronic kidney disease (CKD) is increasing worldwide, and this tendency is also visible in pediatric patients. The major clinical challenge is to achieve a diagnosis as early as possible, despite an overt clinical course, especially in the early [...] Read more.
Background/Objectives: The prevalence of chronic kidney disease (CKD) is increasing worldwide, and this tendency is also visible in pediatric patients. The major clinical challenge is to achieve a diagnosis as early as possible, despite an overt clinical course, especially in the early stages of the disease. Unfavorable external conditions may disturb the proper treatment of chronically ill patients and delay the time of diagnosis. The recent COVID-19 pandemia might have altered the usual diagnostic pathways of different comorbidities, and CKD was probably one of them. However, there are no data on newly diagnosed CKD in children during the time of the pandemia, so our aim was to approach this problem. Methods: We analyzed medical records of 154 children with CKD who were hospitalized in the Department of Pediatric Nephrology in prepandemic (years 2015–2019) vs. pandemic and postpandemic (2020–2024) conditions, analyzing the eGFR value and stage of CKD at diagnosis, the underlying diseases leading to CKD, and sex-related differences. Results: The number of patients who were diagnosed with CKD in both time periods was comparable. Children hospitalized in the years 2020–2024 presented more often with advanced stages of CKD. The trend towards an increasing share of glomerulopathies, acute kidney injury, and unknown causes of CKD was noticeable under pandemic conditions. Conclusions: The COVID-19 pandemic could, probably owing to reduced access to primary healthcare and disrupted routine check-ups, delay the process of diagnosing CKD in children. Full article
(This article belongs to the Special Issue Clinical Epidemiology in Chronic Kidney Disease)
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12 pages, 893 KiB  
Article
Contrast-Induced Nephropathy in Endovascular Patients: A Retrospective Cohort Study from a Vascular Surgery Clinic in Eastern Europe
by Nicu Olariu, Felix-Mihai Maralescu, Flaviu Bob, Iulia Dana Grosu, Razvan Dragota-Pascota, Luciana Marc, Lazar Chisavu, Oana Albai, Ioana Adela Ratiu, Sorin Barac, Andreea Luciana Rață, Adelina Mzi and Adelina Mihaescu
J. Clin. Med. 2025, 14(4), 1172; https://doi.org/10.3390/jcm14041172 - 11 Feb 2025
Viewed by 701
Abstract
Introduction: Contrast-induced nephropathy (CIN) has emerged as a prevalent and serious complication associated with the administration of iodinated contrast media during diagnostic and therapeutic procedures. Given the rising global prevalence of chronic kidney disease(CKD,) it is crucial to gain a deeper understanding of [...] Read more.
Introduction: Contrast-induced nephropathy (CIN) has emerged as a prevalent and serious complication associated with the administration of iodinated contrast media during diagnostic and therapeutic procedures. Given the rising global prevalence of chronic kidney disease(CKD,) it is crucial to gain a deeper understanding of the risks linked to contrast media exposure. Therefore, the aim of this study, conducted at the Vascular Surgery Clinic in a tertiary hospital in Eastern Europe (Timisoara, Romania), is to assess the incidence of CIN and identify its associated risk factors among patients undergoing endovascular interventions. Methods: This retrospective cohort study was conducted using data from patients treated at a vascular surgery clinic in Timisoara, Romania, between 1 January 2018 and 31 December 2023. The study population included adult patients who underwent scheduled endovascular procedures and had serum creatinine measurements both before and after the procedure. Results: A total of 331 patients were included in the analysis (71.42% males with a mean age of 66.79 ± 9.86 years). In total, 9.22% of the patients had CKD, while 23.8% developed CIN. The mean age was significantly higher in the CIN group (68.4 years) compared to the non-CIN group (66.32 years) with a p-value of 0.093, indicating that older age is associated with a higher risk of CIN. A multivariate logistic regression analysis was performed to assess the association between various factors and the development of CIN. Higher hemoglobin levels were associated with reduced odds of CIN (OR = 0.792, 95% CI: 0.659–0.952, p = 0.0148), indicating that anemia is a significant risk factor for CIN, while CKD significantly increased the odds of CIN by 85.8% (OR = 1.858, 95% CI: 1.105–3.125, p = 0.0023), establishing CKD as a critical risk factor for CIN. Conclusions: While anemia and CKD were found to be significant predictors of CIN, further research on a wider population is required to validate these findings and explore additional risk factors. Our study shows that, in the context of elective endovascular procedures, addressing anemia correction and stabilizing creatinine levels to baseline represents a crucial strategy for reducing the risk of CIN. Full article
(This article belongs to the Special Issue Clinical Epidemiology in Chronic Kidney Disease)
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11 pages, 966 KiB  
Article
Rationale and Protocol of the ETERNITY-ITA Study: Use of Etelcalcetide for Preserving Vitamin K-Dependent Protein Activity—An Italian Study
by Maria Fusaro, Andrea Aghi, Carmela Marino, Francesca Mallamaci, Mario Plebani, Martina Zaninotto, Maria Grano, Silvia Colucci, Maurizio Gallieni, Thomas L. Nickolas, Sandro Giannini, Stefania Sella, Paolo Simioni, Alberto Bazzocchi, Giuseppe Guglielmi, Fulvia Taddei, Enrico Schileo, Maria Carmela Versace and Giovanni Tripepi
J. Clin. Med. 2024, 13(19), 5888; https://doi.org/10.3390/jcm13195888 - 2 Oct 2024
Viewed by 1311
Abstract
Background/Objectives: Chronic kidney disease and mineral bone disorders (CKD-MBD) are frequently associated with an increased risk of both vascular calcifications (VCs) and bone fractures (BFs). The complex pathogenesis of VCs and BFs involves various factors such as calcium overload, phosphate imbalance, and secondary [...] Read more.
Background/Objectives: Chronic kidney disease and mineral bone disorders (CKD-MBD) are frequently associated with an increased risk of both vascular calcifications (VCs) and bone fractures (BFs). The complex pathogenesis of VCs and BFs involves various factors such as calcium overload, phosphate imbalance, and secondary hyperparathyroidism. Key players, such as the vitamin K-dependent proteins (VKDPs) matrix Gla protein (MGP) and bone Gla protein (BGP), have pivotal roles both for VCs and BFs. The VIKI study highlighted that hemodialysis patients treated with calcimimetics had higher levels of total BGP and MGP compared to those untreated, suggesting a potential protective effect of these drugs on BFs and VCs beyond the beneficial effect of reducing PTH levels. Methods: ETERNITY-ITA is a multi-center, comparative effectiveness, observational, longitudinal study that will enroll 160 hemodialysis patients (80 patients treated with Etelcalcetide and 80 age- and sex-matched patients treated with calcitriol or vitamin D analogs). Nephrologists will tailor the target dose of Etelcalcetide on an individual level to achieve the KDIGO PTH target. In the Etelcalcetide-treated group, the addition of calcitriol will be allowed when required by clinical practice (for correction of hypocalcemia). Conclusions: This study will evaluate the real-world effect of Etelcalcetide on VKDP levels, such as BGP and MGP, at 3, 9, and 18 months from baseline. The resulting preservation of vascular and bone health will be assessed for the first time by examining aortic and iliac artery calcifications and vertebral fractures, respectively. Full article
(This article belongs to the Special Issue Clinical Epidemiology in Chronic Kidney Disease)
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11 pages, 1121 KiB  
Article
Impact of Serum Phosphate on Hemoglobin Level: A Longitudinal Analysis on a Large Cohort of Dialysis Patients
by Vincenzo Calabrese, Giovanni Luigi Tripepi, Domenico Santoro, Valeria Cernaro, Vincenzo Antonio Panuccio, Sabrina Mezzatesta, Francesco Mattace-Raso, Claudia Torino and on behalf of the Sicilian Registry of Nephrology, Dialysis and Transplantation
J. Clin. Med. 2024, 13(19), 5657; https://doi.org/10.3390/jcm13195657 - 24 Sep 2024
Cited by 5 | Viewed by 1369
Abstract
Background/Objectives: Phosphate is a macro-element involved in all cellular energetic processes. As about 90% of the phosphate filtered by the glomerulus is excreted by kidneys, the impairment of renal function and the consequent over-secretion of parathyroid hormone and fibroblast growth factor 23 [...] Read more.
Background/Objectives: Phosphate is a macro-element involved in all cellular energetic processes. As about 90% of the phosphate filtered by the glomerulus is excreted by kidneys, the impairment of renal function and the consequent over-secretion of parathyroid hormone and fibroblast growth factor 23 results in the increase in the serum phosphate levels. The association between phosphate and hemoglobin is controversial, as both direct and indirect relationships have been reported. The present study aims to investigate the relationship between phosphate and hemoglobin in a large prospective, longitudinal cohort including dialysis patients from the Sicilian Registry of Nephrology, Dialysis, and Transplantation. Methods: In this prospective cohort study, we included 6263 hemodialysis patients to achieve a total of 120,462 repeated measurements of serum phosphate and hemoglobin over time. The longitudinal association between phosphate and hemoglobin was analyzed by univariate and multivariate Linear Mixed Models. Results: The mean age was 66 ± 16 years and the median dialysis vintage was 5 months [IQR: 2–16]. Mean and median values of hemoglobin and phosphate were 10.7 g/dL (SD 1.3 g/dL) and 4.6 mg/dL [IQR 3.9–5.5 mg/dL], respectively. The multivariate model, adjusted for potential confounders, confirmed the positive association between serum phosphate and hemoglobin [adjβ = 0.13, 95%CI 0.03–0.23, p = 0.01)]. These results were confirmed in analyses stratified for the use of phosphate binders. Conclusions: In our large cohort of dialysis patients, we found a linear, direct relationship between phosphate and hemoglobin levels. As a reduction in phosphate is associated with a parallel reduction in hemoglobin levels, hypophosphatemia can accentuate anemia in dialysis patients. Our results generate the hypothesis that monitoring serum phosphate in clinical practice might provide a better management of anemia. Full article
(This article belongs to the Special Issue Clinical Epidemiology in Chronic Kidney Disease)
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