International Journal of Nephrology and Renovascular Disease最新文献

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.

Background: Cisplatin is a cornerstone chemotherapeutic agent used widely to treat various solid malignancies. Despite its efficacy, the usage of cisplatin is limited by its dose-dependent nephrotoxicity causing cisplatin-induced acute kidney injury (AKI) in up to 45% of treated patients. Current preventive strategies are limited to supportive measurement resulting in questionable clinical outcomes. N-acetylcysteine (NAC), a thiol-containing compound with antioxidant and anti-inflammatory properties, is already known for its safety.

Purpose: This review aims to explore the mechanisms of cisplatin-induced AKI, the role of NAC in its prevention, and the current evidence.

Methods: A narrative review has been conducted of several literature, including preclinical and clinical studies evaluating NAC's efficacy in preventing cisplatin-induced AKI.

Results: Cisplatin has cytotoxic effect via DNA structures disruption, leading to impairment of cell repair mechanism, triggering apoptosis that works effectively against cancer cells. However, cisplatin also accumulates in renal proximal tubular epithelial cells, disrupting DNA structures, increasing reactive oxygen species (ROS), inducing mitochondrial dysfunction and inflammation, all leading to apoptosis. NAC can counteract these mechanisms by scavenging ROS directly via its thiol group and indirectly by replenishing glutathione. Preclinical studies have demonstrated consistent NAC nephroprotective effects. However, findings from clinical studies remain inconsistent due to limited sample sizes, varied dosing regimens, and differences in administration routes, making comparison between studies difficult to conduct.

Conclusion: NAC exhibits strong nephroprotective properties through antioxidant, anti-inflammatory, and cytoprotective mechanisms as consistently shown in preclinical studies. Despite the limited current clinical evidence supporting these findings, NAC remains a promising agent for cisplatin-induced AKI prevention. Future research should focus on large-scale, well-designed, standardized clinical trials with optimized dosing strategies to validate NAC's efficacy and establish its clinical role.

Background: Autosomal dominant polycystic kidney disease (ADPKD), the most common inherited kidney disorder, is frequently accompanied by hypertension, with each condition potentially exacerbating the other. This study employs a bidirectional Mendelian randomization (MR) design to investigate the causal relationship between PKD and hypertension, alongside bioinformatics analyses to explore underlying genetic mechanisms.

Methods: Genetic data for PKD and hypertension were obtained from the International Epidemiology Unit (IEU) Genome-Wide Association Study (GWAS) database. A bidirectional MR analysis was performed using nucleotide polymorphisms (SNPs) strongly associated with PKD and hypertension. Genetic annotation and enrichment analysis of SNPs were conducted using the Functional Mapping and Annotation (FUMA) platforms. Gene expression differences between PKD and controls were studied using the GEO database and single-cell data analysis tools. Quantitative PCR analysis of ARL13B mRNA levels in normal renal tubular epithelial cells (RCTEC), renal cystic epithelial cells (WT9-12), and ADPKD kidney tissues.

Results: MR analysis demonstrated a causal effect of PKD on hypertension (IVW: P=0.038; OR=1.011; 95% CI: 1.001-1.021) and a reverse causal effect of hypertension on PKD (IVW: P=0.042; OR=1.195; 95% CI: 1.007-1.420). No significant heterogeneity or pleiotropy was detected. Genetic annotation identified 27 PKD genes closely associated with hypertension. Among them, functional enrichment analysis indicated ARL13B was involved in cilia morphology and dysfunction. Notably, RT-PCR results showed that ARL13B mRNA expression was significantly elevated in human ADPKD kidneys (P<0.001) and WT9-12 cells (P<0.05).

Conclusion: Our bidirectional MR study demonstrated a causal effect of PKD on hypertension and a reverse influence of hypertension on PKD progression. Elevated ARL13B expression in ADPKD suggested a possible involvement of cilia-related pathways in the development of renal hypertension.

Purpose: To evaluate the effect of a novel follow-up mode integrating specialist nurse-led care and an intelligent platform on fluid volume management in patients with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD).

Patients and methods: A pre- and post-observational clinical cohort of 80 PD patients (Shanghai General Hospital South, Mar 2020-Mar 2021) evaluated the 12-month impact of the novel mode on fluid volume overload (FVL), cardiac function, laboratory indicators (including biochemical parameters and electrolytes), and clinically relevant complications (peritonitis, exit-site/tunnel infection and catheter displacement).

Results: After 12 months of follow-up using the novel mode, significant improvements were observed compared to the traditional follow-up approach. Specifically, levels of B-type natriuretic peptide (BNP) (144.12±14.21 vs 631.01±104.21 pg/mL, P < 0.001), systolic blood pressure (SBP) (136.99±12.04 vs 145.34±15.22 mmHg, P < 0.001), and diastolic blood pressure (DBP) (79.03±6.35 vs 84.87±8.17 mmHg, P < 0.01) were significantly lower in patients managed with the novel mode. Additionally, blood calcium (2.24±0.52 vs 2.18±0.02 pg/mL, P < 0.05), phosphorus (1.96±0.07 vs 1.80±0.06 mmol/L, P < 0.01), parathyroid hormone (PTH) (409.28±43.49 vs 250.84±23.26 pg/mL, P < 0.001), and albumin (38.89±0.60 vs 36.25±0.51 pg/mL, P < 0.001) levels were higher following implementation of the novel mode. FVL and cardiac function also showed significant improvement over the 12-months follow-up period. Notably, compared with the preceding 12-month control period, the platform-based follow-up reduced clinically relevant infectious complications from 10.3% to 3.8% (McNemar mid-p = 0.077).

Conclusion: The novel follow-up mode effectively reduced fluid volume overload and improved cardiac function, offering clinical benefits for PD patients.

Uric acid nephropathy (UAN), driven by sustained hyperuricemia, is an underrecognized but increasingly prevalent contributor to chronic kidney disease (CKD) progression. Mitochondrial oxidative stress and vascular remodeling are central to its pathogenesis. Excess mitochondrial reactive oxygen species (ROS) cause renal tubular injury, impair mitophagy, and activate pro-apoptotic signaling pathways. In parallel, ROS disrupt endothelial homeostasis, promote phenotypic switching of vascular smooth muscle cells, and induce pathological structural changes in the renal microvasculature. These processes are mutually reinforcing, thereby exacerbating inflammation, hypoxia, and fibrosis. This review synthesizes emerging mechanistic insights into the mitochondrial-vascular axis in UAN and discusses therapeutic strategies targeting mitochondrial dysfunction and vascular pathology. Particular emphasis is placed on mitochondria-targeted antioxidants and inhibitors of key signaling pathways as potential interventions to interrupt the ROS-remodeling cycle. We also highlight the need for biomarker development and clinical translation. A more comprehensive understanding of mitochondrial-vascular crosstalk may ultimately enable the development of effective strategies to slow or halt UAN progression.

Purpose: Unhealthy behaviors can accelerate the progression of chronic kidney disease (CKD). This study aimed to evaluate the effectiveness of a community-based integrated care program in modifying key unhealthy behaviors among CKD patients in rural Thailand and to assess the impact of these behaviors on the rate of kidney function decline.

Patients and methods: This is a post-hoc analysis of the ESCORT-2 trial, which is a 3-year prospective cohort study that enrolled 914 patients with CKD stages 3-4 in rural Thailand. Participants received an integrated care program involving hospital-based multidisciplinary teams and home-based community care networks. Seven unhealthy behaviors were assessed annually: usage of herbal medicines, analgesics, and non-steroidal anti-inflammatory drugs (NSAIDs); being overweight; lack of regular exercise; moderate-to-high salt intake; and high protein intake. Data were collected through patient interviews and standardized questionnaires. Changes in the prevalence of these behaviors were analyzed over three years, and the association between persistent unhealthy behaviors and the rate of eGFR decline was examined.

Results: Over the 3-year study period, the integrated care program led to significant and sustained reductions in the use of herbal medicines (23.3% to 5.0%), analgesics (34.9% to 7.8%), and NSAIDs (4.3% to 1.3%) (all p<0.0001). Moderate-to-high salt intake also significantly decreased (22.1% to 14.1%, p<0.0001). However, no significant improvement was observed in the prevalence of overweight or high protein intake. While individual persistent unhealthy behaviors did not significantly correlate with the rate of estimated glomerular filtration rate (eGFR) decline, patients with a baseline accumulation of three or more unhealthy behaviors exhibited a significantly faster eGFR decline compared to those with fewer unhealthy behaviors (-2.04 vs -1.02 mL/min/1.73 m², p<0.001).

Conclusion: An integrated care model implemented in a primary care setting can effectively reduce medication- and dietary-related unhealthy behaviors in CKD patients. However, fostering sustained improvements in complex lifestyle behaviors such as weight control and regular exercise remains a significant challenge.