International Journal of Nephrology and Renovascular Disease最新文献

Purpose: This study seeks to highlight the impact of clinical pharmacists in protecting hemodialysis patients from catheter-related infections. By ensuring appropriate antimicrobial use, guiding patients on prevention practices, and collaborating with the healthcare team. This study also examines how pharmacists improve safety, treatment adherence, and quality of life.

Patients and methods: This randomized interventional study was conducted between November 2024-April 2025. Patients were divided into intervention and non-intervention groups. The care bundle comprised culture-guided antibiotic locks (except gentamicin-heparin), in-hospital exit-site dressing with 3M Tegaderm by trained staff, and safety medication checks (e.g, blood-pressure monitoring before the use of erythropoiesis-stimulating agents) were used. The primary endpoint was the incidence of catheter-related bloodstream infections (CRBSIs); secondary endpoints were length of stay, admissions, ICU admissions, catheter replacements, and death. Monthly averages of vitals, drug therapy problems (DTPs), and laboratory parameters were obtained for both groups.

Results: A total of ninety patients included in this study. The patients were randomly assigned to either the intervention or non-intervention group and a total 81 out of 90 patients successfully completed the study. After four visits and six months of implementing infection control measures within the context of pharmaceutical care, the infection rate showed a significant reduction in the intervention group (from 0.64±0.48 to 0.20±0.4, p =0.0001) compared with the non-intervention group (0.66±0.48 to 0.71±0.45, p =0.9731). The mean differences increased over time, reaching 0.26 (95% CI of diff.= 0.09 to 0.43) at visit 1, 0.41 (95% CI of diff.= 0.24 to 0.58) at visit 3, and 0.51 (95% CI of diff.= 0.34 to 0.68) at visit 4.

Conclusion: Clinical pharmacist intervention via implementing infection control within the context of a pharmaceutical-care process can improve infection rates among hemodialysis patients.

Background: CIH, the hallmark of OSA, is a recognized driver of multi-organ injury. While its contribution to renal dysfunction is acknowledged, the specific roles of key senescence-regulating pathways-particularly the PI3K/Akt/p21 axis and the anti-aging protein Klotho-in CIH-induced renal senescence remain largely unexplored.

Purpose: This study aimed to investigate the effects of CIH and subsequent normoxic reoxygenation on renal senescence in rats, and to elucidate the dynamic involvement of the PI3K/Akt/p21 pathway and the anti-aging protein Klotho in this process.

Methods: Forty 5-week-old male Sprague-Dawley rats were randomly assigned to NC and CIH groups. The CIH group was exposed to IH (range 6.5-7.5%, 30 cycles/h, 8 h/day) for 8 weeks, followed by a 4-week normoxic recovery period. Renal function (SCr, BUN,CysC), histopathology (cortex-to-medulla ratio, tubular epithelial density), and the expression of senescence-related molecules (p21, Klotho, PI3K/AKT pathway components) were assessed at weeks 0, 8, and 12. Statistical significance was determined by two-way ANOVA with Tukey's post hoc test.

Results: Following 8 weeks of CIH exposure, rats exhibited significant renal dysfunction, with SCr increased by 21.3%, BUN by 24.0%, and CysC by 27.9% compared to controls (all P<0.05), alongside histopathological alterations including cortical atrophy, medullary expansion, and reduced tubular epithelial density (P<0.05).These changes were associated with upregulation of p21 and downregulation of PI3K/AKT signaling and Klotho (P<0.05). After 4 weeks of normoxic recovery, renal function and PI3K/Akt/p21 signaling were largely restored (P>0.05 vs NC). However, cortical-medullary structural imbalance and suppressed Klotho expression persisted (P<0.05). Statistical significance was determined by two-way ANOVA with Tukey's post hoc test).

Conclusion: CIH induces a partially reversible renal senescence phenotype in rats, which is associated with dynamic modulation of the PI3K/Akt/p21 axis. The persistent suppression of Klotho may underlie irreversible structural injury, providing novel mechanistic insights into OSA-associated kidney disease.

Background: Albuminuria is a key marker for the early detection of chronic kidney disease (CKD) in patients with diabetes mellitus and hypertension. Despite guideline recommendations for albuminuria testing in these high-risk populations, adherence remains suboptimal.

Methods: A retrospective study was conducted at a tertiary center in Al-Ahsa, Saudi Arabia. Data were collected from the records of 516 adults with diabetes mellitus, hypertension, or both. Patients with CKD were excluded. The primary outcome was the rate of albumin-to-creatinine ratio (ACR) testing.

Results: Among 516 patients (mean age 63.7 ± 7.6 years), the overall prevalence of ACR testing was 59.1%. Testing was highest in the diabetes-only subgroup (69.5%), followed by the diabetes with hypertension subgroup (66.3%), and lowest in the hypertension-only subgroup (19.3%) (p<0.001). Testing was more likely in patients with high HbA1c, more outpatient visits, and among individuals using angiotensin receptor blockers (ARBs) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors. After adjustment, hypertension-only patients were less likely to be tested (adjusted odds ratio [AOR] = 0.14; 95% CI: 0.07-0.31), whereas the use of ARBs (AOR = 3.17; 95% CI: 1.69-5.93) and SGLT2 inhibitors (AOR = 3.00; 95% CI: 1.31-6.90) was independently associated with increased testing. Of those tested, 40% had albuminuria (A2 or A3).

Conclusion: Albuminuria testing is substantially underutilized among high-risk patients in Saudi Arabia. Individuals with hypertension only are the least likely to undergo screening. This suggests a gap between clinical practice and guideline recommendations. These findings highlight the need for strategies to improve early CKD detection, particularly in primary care.

Chronic kidney disease (CKD) is an increasing public health challenge, affecting about 11% of adults worldwide. Kidney diseases are now the third fastest-growing cause of death globally, and the number of patients reaching end-stage kidney disease continues to rise, resulting in growing demand for renal replacement therapy. A variety of clinical and individual factors influence the management of the disease. However, meaningful patient participation in this process is only possible when patients possess adequate knowledge of their disease and treatment options. Patient education is therefore a fundamental component of CKD management. It promotes behaviors that improve disease control and slow disease progression, while empowering patients to actively engage in shared decision-making and enhancing quality of life. Although both Polish and international guidelines highlight the need for structured education and its integration into comprehensive care models, practical recommendations on how such programs should be organized remain scarce. This article presents an expert opinion based on clinical experience and current literature. The recommendations outline key principles for designing and implementing high-quality educational initiatives that can be applied across nephrology centers and tailored to different stages of CKD. They also provide a framework for establishing a nationwide nephrology education system built on best practices and evidence-based standards.

Kidney disease is a major public health challenge, affecting millions of people worldwide. Conventional treatments often produce suboptimal outcomes and are associated with various adverse effects. Traditional Chinese Medicine has shown promising therapeutic potential, offering distinct advantages over conventional therapies for preventing and treating kidney diseases. Salvianolic acids, the principal bioactive constituents of Salvia miltiorrhiza, are widely used in the management of renal disorders. However, no dedicated review has systematically synthesized pharmacological evidence across different models of kidney disease. To advance both basic research and clinical applications, this review summarizes current knowledge on the therapeutic effects of salvianolic acids in acute kidney injury, diabetic kidney disease, and nephrotic syndrome. Their renoprotective actions arise from the modulation of multiple pathological processes, including inflammation, oxidative stress, apoptosis, mitochondrial dysfunction, endoplasmic reticulum stress, and autophagy dysregulation. Collectively, salvianolic acids hold promise as potential therapeutic agents for kidney diseases. Further studies are needed to confirm these molecular mechanisms and identify specific targets. Additionally, large-scale, long-term, multicenter clinical trials are crucial to evaluate the efficacy and safety of salvianolic acids in treating kidney diseases.

Background: Haemodialysis (HD) is the predominant kidney replacement therapy for end-stage kidney disease (ESKD) in Indonesia, whereas continuous ambulatory peritoneal dialysis (CAPD) is less frequently used. Hypertension is highly prevalent in this population and may impair health-related quality of life (HRQoL). This study aimed to compare HRQoL between HD and CAPD patients using the EQ-5D-5L instrument.

Methods: A prospective observational cohort study was conducted at Dr. Hasan Sadikin General Hospital, Bandung (September 2023-January 2024). Adults with ESKD and hypertension on HD or CAPD for ≥3 months were assessed at baseline, week 2 and week 4 using EQ-5D-5L and EQ-VAS. Socio-demographic and clinical data were obtained from medical records. Baseline differences were examined using χ²/Fisher's exact and Mann-Whitney U-tests. Longitudinal changes in EQ-5D-5L utility and EQ-VAS were analysed using linear mixed-effects models (LMMs) with random intercepts and fixed effects for time, dialysis modality, age and comorbidity; age×comorbidity and time×comorbidity interactions were explored.

Results: Ninety-one patients were included (58 HD, 33 CAPD). Compared with HD, CAPD patients were younger, more highly educated, more often insured through non-PBI schemes, and had greater comorbidity burden, more frequent use of ≥3 antihypertensive drugs and higher rehospitalisation rates. Mean EQ-5D-5L utility and EQ-VAS scores were similar between modalities at all time points. In LMMs, neither modality nor time showed significant main effects on EQ-5D-5L utility or EQ-VAS (all p>0.05). For utility, significant age×comorbidity (p=0.002) and time×comorbidity (p=0.032) interactions indicated less favourable trajectories among older, multimorbid patients.

Conclusion: After accounting for repeated measurements and baseline confounding, short-term overall HRQoL appeared broadly comparable between HD and CAPD. Small numerical advantages for CAPD and the interaction patterns observed in LMMs should be considered hypothesis-generating and require confirmation in larger, methodologically robust studies.

Aim: This study aimed to identify the predictors of self-management in patients undergoing maintenance hemodialysis, with the goal of informing future interventions to improve self-management capabilities.

Design: A cross-sectional survey was conducted involving 341 patients undergoing maintenance hemodialysis.

Methods: Based on the framework of triadic reciprocal determinism, self-management was evaluated using the Self-Management Scale, while fluid intake motivation was assessed via the Compliance Scale for Fluid Intake Motivation. Autonomous perception was measured using the Chinese version of the PEA Scale. Intergroup comparisons were performed using independent-samples t-tests and one-way analysis of variance (ANOVA). Pearson correlation analysis was applied to examine the correlations among self-management, fear of disease progression, fluid intake motivation, and autonomous perception. Variable selection was performed using the Random Forest model and Lasso analysis, after which the identified variables were incorporated into a multiple linear stepwise regression for multivariate analysis.

Results: The mean total self-management score among patients with maintenance hemodialysis was 52.39 ± 6.97 (SD), indicating a moderate level of self-management. Multiple linear stepwise regression analysis identified residence, educational level, motivation for fluid intake, and autonomous perception as the main predictors of self-management (P < 0.05). Together, these factors explained 28.5% of the total variance in self-management.

Conclusion: Self-management among patients undergoing maintenance hemodialysis is at a moderate level. Guided by this predictive model, healthcare providers can develop targeted nursing strategies to assist patients with self-management practices and ultimately enhance their self-management outcomes.

Purpose: Financial toxicity (FT) describes the strain individuals and families feel when they struggle with money due to medical expenses and related costs associated with their healthcare. Management of chronic kidney disease is expensive. The aim of this study was to detect FT in Italian patients undergoing renal replacement therapy.

Patients and methods: FT was investigated using the Patient-Reported Outcome for Fighting Financial Toxicity (PROFFIT) questionnaire in 238 individuals, of whom 147 (61.8%) received hemodialysis, 30 (12.6%) peritoneal dialysis, and 61 had renal transplantation (25.6%). The PROFFIT score was normalized to a 0-100% range, with 100% indicating the highest level of toxicity, and mean values were compared in the different groups of uremic patients stratified by age, sex and treatment.

Results: Mean age of the population was 66.2±13.7 years (range 23-89). The probability of FT due to financial distress in the whole population that was 42.1±24.1%, whilst mean probability of FT due to medical expenses response was 44.9±27.6%, mean probability of FT due to transportation response was 37.1±29.4% and mean probability of FT due to support from the Health System was 25.5±23.3%. FT was higher in the hemodialysis group.

Conclusion: Hemodialysis patients showed worse financial burden than peritoneal dialysis and kidney transplanted patients, while peritoneal dialysis subjects felt better cared for by health care professionals than kidney transplanted individuals, however the latter group could afford monthly expenses better than hemodialysis patients. Health care professionals should discuss financial problems or other social challenges that may impact on the health of uremic individuals.

Continuous Ambulatory Peritoneal Dialysis (CAPD) is a flexible renal replacement therapy that is widely used in developing and middle-income countries. Despite being beneficial, CAPD remains vulnerable to complications, such as peritonitis and fluid overload. In this systematic review, two prevailing artificial intelligence (AI) paradigms-rule-based systems and automatic machine learning approaches- were compared to enhance CAPD monitoring and decision-making. Literature published between January 1, 2020, to May 20, 2025, was assessed for clinical effectiveness, patient adherence, operational efficiency, cost, and usability. Automated AI systems for dialysate image classification have also been examined. Our findings suggest that automated AI systems provide greater precision and earlier detection, whereas rule-based models offer practical advantages in a low-resource structured environment such as Indonesia's healthcare system. These findings validate the value of integrating both paradigms, and propose a hybrid integration model to achieve the highest clinical accuracy, cost-effectiveness, and accessibility for CAPD monitoring. A total of 156 articles were identified, including 42 from PubMed, 37 from Scopus, 58 from Google Scholar, and 19 from IEE Xplore. Following screening and eligibility assessment, 24 studies were included for full synthesis. Of these, 12 investigated automated AI systems including machine learning based dialysate image classification and predictive modeling while 3 evaluated rule-based systems using predefined clinical logic. Overall 14 studies were identified as eligible studies that assessed the implementation of AI systems for the monitoring and management of CAPD. The proposed hybrid implementation model combines the strengths of both paradigms, tailored to national clinical guidelines and insurance schemes.

Background: Chronic kidney disease (CKD) is a major global health concern worldwide. CKD has become a major health concern in the Kingdom of Saudi Arabia (KSA) owing to rising rates of diabetes and hypertension. This study aimed to evaluate the knowledge and competence of healthcare professionals in KSA regarding CKD management, focusing on aspects such as screening, diagnosis, complications, and treatment, based on the latest evidence-based guidelines.

Methods: A cross-sectional study was conducted among healthcare professionals involved in management of patients with CKD and DM patients in the KSA. The duration of the study was six months, that is, September 1, 2024, to February 28^th, 2025. A validated self-administered questionnaire was used to assess the participants' confidence in different aspect of CKD management. The data was analyzed using descriptive statistics, the relative importance index (RII) and univariate binary logistic regression to identify factors associated with higher confidence using SPSS.

Results: A total of 391 healthcare professionals were included in this study. Among the healthcare professionals recruited, 54.0% were age group-28-37 years and 52.2% were pharmacists. The regression analysis showed diabetologists demonstrated the highest confidence in selecting appropriate CKD management (OR = 9.78, 95% CI: 2.39-39.96, p = 0.002), 5.16 times higher odds for understanding ACE-Is/ARBs (OR = 5.16, 95% CI 1.40-19.10, p = 0.014), and 6.09 times higher odds for initiating newer agents for diabetic kidney disease (OR = 6.09, 95% CI: 1.67-22.30, p = 0.006). Confidence increased progressively with professional experience, particularly among those with 3-4 years (OR = 5.14, 95% CI 1.63-16.25), 7-8 years (OR = 8.40-14.58, 95% CI 2.46-54.81), and 9-10 years (OR = 11.25-15.87, 95% CI 2.52-78.32; p < 0.01).

Conclusion: Confidence in CKD management among healthcare professionals in Saudi Arabia was variable and influenced by professional role and experience. Diabetologists and those with 3-10 years of experience reported significantly higher confidence. These findings underscore the need for targeted educational interventions to strengthen CKD management confidence and capacity among primary care professionals.