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Medicina
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Chronic Kidney Disease: From Early Detection to Modern Management Strategies
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Chronic Kidney Disease: From Early Detection to Modern Management Strategies

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Urology & Nephrology".

Deadline for manuscript submissions: 20 December 2026 | Viewed by 2182

Special Issue Editor

Dr. Domenico Giannese

E-Mail Website
Guest Editor
1. Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy
2. Department of Nephrology, Policlinico University, 56121 Pisa, Italy
Interests: clinical nephrology; immunology; modern pharmacological approach; chronic kidney disease

Special Issue Information

Dear Colleagues,

In recent years, the treatment of chronic kidney disease (CKD) has become a priority in light of its impact on public health: a 7.7% increase is expected in CKD incidence by 2032. Recently, there has been a radical shift in focus from approaches on risk factor prevention to interventions in disease cases.  Newly introduced therapies, such as SGLT2 inhibitors and non-steroidal MRIs, aim to reduce the progression of chronic kidney disease and prevent end-stage kidney disease as their clinical impacts. The benefits are evident in all stages of kidney disease and will produce benefits over time including a reduced need for dialysis, a reduced need for transplants and reductions in costs. Therefore, from this perspective, it is essential to stratify patients who would benefit from optimizing nephroprotective treatment as early on in the disease course as possible. The aim of this Special Issue is to explore these aspects, looking at past developments, focusing on present progress and looking towards possible future advancements in reducing the progression of CKD and improving long-term outcomes. Original papers, experimental papers, and reviews will be considered and reviewed for the Special Issue.

Dr. Domenico Giannese
Guest Editor

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-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina 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 2200 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

  • proteinuria
  • chronic kidney disease
  • SGLT2-I
  • management of CKD
  • nephroprotection

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Published Papers (2 papers)

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Research

10 pages, 437 KB  
Article
Trajectories of Kidney Function in Autosomal Dominant Polycystic Kidney Disease Patients Treated with Tolvaptan
by Zofia Jankowska and Mariusz Niemczyk
Medicina 2026, 62(1), 194; https://doi.org/10.3390/medicina62010194 - 16 Jan 2026
Viewed by 1203
Abstract
Background and Objectives: Autosomal dominant polycystic kidney disease (ADPKD) is the most common monogenic kidney disease, and the only approved pharmacological therapy shown to slow disease progression is tolvaptan. This study presents a long-term observation of ADPKD patients treated at our center, focusing [...] Read more.
Background and Objectives: Autosomal dominant polycystic kidney disease (ADPKD) is the most common monogenic kidney disease, and the only approved pharmacological therapy shown to slow disease progression is tolvaptan. This study presents a long-term observation of ADPKD patients treated at our center, focusing on changes in eGFR approximately one year before and at least 1 year after the initiation of tolvaptan therapy. Materials and Methods: A retrospective analysis of a cohort of ADPKD patients who have received tolvaptan treatment in our center. Results: In total, 20 patients were enrolled in the analysis. Their median time of observation since tolvaptan introduction was 23.5 months. No statistically significant difference was noted in the median monthly decrease in eGFR between the time prior to tolvaptan introduction and during tolvaptan therapy. Analysis of trajectories of eGFR in particular patients enabled the division of the cohort into three subgroups: beneficiaries (n = 7, 35%), stable (n = 8, 40%), and progressors (n = 5, n = 25%). Conclusions: Despite the low number of patients, together with a relatively short observation period, which are the main limitations of our study, our results suggest that, in real-world settings, the efficacy of tolvaptan may be lower than previously reported. There is an urgent need to identify factors responsible for the suboptimal effect of the medicine. Our findings underscore the need to re-evaluate the current inclusion criteria for tolvaptan, particularly in real-world settings where patient variability is broader than in controlled clinical trials. Tailoring treatment qualification to include more practical and region-specific factors may enhance therapeutic outcomes. Full article
(This article belongs to the Special Issue Chronic Kidney Disease: From Early Detection to Modern Management Strategies)
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12 pages, 1335 KB  
Article
Active Vitamin D Level Is Independently Associated with the Presence and Severity of Coronary Artery Disease in Patients with Chronic Kidney Disease
by Il Young Kim
Medicina 2026, 62(1), 124; https://doi.org/10.3390/medicina62010124 - 7 Jan 2026
Viewed by 571
Abstract
Background and Objectives: Chronic kidney disease (CKD) increases the risk of coronary artery disease (CAD), and vitamin D deficiency—particularly reduced levels of 1,25-dihydroxyvitamin D [1,25(OH)2D], the biologically active form of vitamin D that declines early in CKD due to impaired renal [...] Read more.
Background and Objectives: Chronic kidney disease (CKD) increases the risk of coronary artery disease (CAD), and vitamin D deficiency—particularly reduced levels of 1,25-dihydroxyvitamin D [1,25(OH)2D], the biologically active form of vitamin D that declines early in CKD due to impaired renal conversion—may be a contributing factor. This study aimed to assess the relationship between 1,25(OH)2D levels and the presence and severity of CAD in CKD patients. Materials and Methods: We retrospectively analyzed 398 non-dialysis CKD patients (eGFR < 60 mL/min/1.73 m2) who underwent elective coronary angiography. Serum 1,25(OH)2D and 25(OH)D levels were measured, and CAD severity was assessed using the Gensini score. Results: Lower 1,25(OH)2D levels were independently associated with both the presence and se-verity of CAD. Logistic regression revealed that each 1 pg/mL increase in 1,25(OH)2D was linked to an 11% reduction in odds of significant CAD (OR: 0.89; 95% CI: 0.86–0.93; p < 0.001). In contrast, 25(OH)D was not significantly related to CAD. Linear regression showed an inverse correlation between 1,25(OH)2D and Gensini scores (β = −0.329, p < 0.001), indicating reduced disease severity with higher vitamin D levels. Subgroup analyses confirmed consistent associations across age, sex, diabetes, hypertension, and LDL-cholesterol categories. ROC analysis demonstrated that 1,25(OH)2D alone had good predictive ability for CAD (AUC = 0.818), which improved to 0.925 when combined with traditional risk factors. The optimal cutoff for 1,25(OH)2D was ≤16.6 pg/mL, yielding 73.3% sensitivity and 83.5% specificity. Conclusions: Serum 1,25(OH)2D is an independent predictor of both the presence and extent of CAD in CKD patients and may serve as a valuable non-traditional biomarker for cardiovascular risk assessment. Full article
(This article belongs to the Special Issue Chronic Kidney Disease: From Early Detection to Modern Management Strategies)
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