Low birth weight (LBW), which is indicative of impaired fetal growth, is associated with the development of both nephrons and podocytes, increasing the risk of kidney disease later in life. However, the clinical evidence remains limited. We herein reported 3 patients with a history of LBW who developed overt proteinuria during adolescence. Using kidney biopsy samples from these patients, we conducted a comprehensive morphometric analysis of nephrons and podocytes. Compared with healthy and diseased kidney controls, all 3 cases exhibited a profoundly reduced number of nephrons, lower podocyte density, and pronounced hypertrophy of both glomeruli and podocytes. Lifestyle modifications and treatment with renin-angiotensin-aldosterone system inhibitors and/or sodium-glucose cotransporter 2 inhibitors led to a reduction in proteinuria but did not achieve complete remission. Our findings highlighted the limitations of current therapeutic strategies and emphasized the urgent need for early and targeted interventions in this high-risk population. An integrated approach that simultaneously evaluates nephrons and podocytes holds promise for advancing research and for enhancing clinical strategies for LBW individuals across diverse causes and life stages.
{"title":"Nephron and Podocyte Metrics in Adolescents With a History of Low Birth Weight: A Three-Case Report","authors":"Yuya Yamaguchi , Takaya Sasaki , Kotaro Haruhara , Takeshi Tosaki , Daisuke Nakashima , Yu Honda , Shinya Yokote , Nobuo Tsuboi , Takashi Yokoo","doi":"10.1016/j.xkme.2025.101230","DOIUrl":"10.1016/j.xkme.2025.101230","url":null,"abstract":"<div><div>Low birth weight (LBW), which is indicative of impaired fetal growth, is associated with the development of both nephrons and podocytes, increasing the risk of kidney disease later in life. However, the clinical evidence remains limited. We herein reported 3 patients with a history of LBW who developed overt proteinuria during adolescence. Using kidney biopsy samples from these patients, we conducted a comprehensive morphometric analysis of nephrons and podocytes. Compared with healthy and diseased kidney controls, all 3 cases exhibited a profoundly reduced number of nephrons, lower podocyte density, and pronounced hypertrophy of both glomeruli and podocytes. Lifestyle modifications and treatment with renin-angiotensin-aldosterone system inhibitors and/or sodium-glucose cotransporter 2 inhibitors led to a reduction in proteinuria but did not achieve complete remission. Our findings highlighted the limitations of current therapeutic strategies and emphasized the urgent need for early and targeted interventions in this high-risk population. An integrated approach that simultaneously evaluates nephrons and podocytes holds promise for advancing research and for enhancing clinical strategies for LBW individuals across diverse causes and life stages.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101230"},"PeriodicalIF":3.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-16DOI: 10.1016/j.xkme.2025.101196
Xu Shi , Yuxi He , Xiuya Zhou , Zhang Zhang , Ling Nie , Xingming Zhang , Hao Zeng
Perinephric myxoid pseudotumor of fat (PMPF) is a rare and highly heterogeneous disease consisting of mature fat, myxoid stroma with spindled or stellate stromal cells histologically. Here, we present 2 cases of PMPF occurring in an allograft and a native kidney, and a systematic review that included 120 previously reported cases was subsequently conducted. Notably, 89% of PMPF cases with documented medical history had comorbidities. The most common comorbidities were urologic neoplasm (45%), chronic kidney disease (23%), allograft kidney (16%), and urinary tract obstruction (5%). We propose a classification of PMPF based on comorbidities and discovered that patients with concomitant urologic neoplasm or obstruction tended to have significantly smaller tumors, and active surveillance of PMPF after treating the primary disease might be an appropriate approach. In contrast, for patients with kidney transplants, chronic kidney disease, or no identifiable primary disease, the tumors were generally larger; therefore, surgical intervention should be considered. Regardless of the classification method used, for tumors exhibiting a slow growth rate, active surveillance should be considered. Our findings aimed to facilitate more accurate differential diagnosis and optimize treatment options.
{"title":"Perinephric Myxoid Pseudotumor of Fat: Case Series, Systematic Review of the Literature, Clinical Classification, and Treatment Implications","authors":"Xu Shi , Yuxi He , Xiuya Zhou , Zhang Zhang , Ling Nie , Xingming Zhang , Hao Zeng","doi":"10.1016/j.xkme.2025.101196","DOIUrl":"10.1016/j.xkme.2025.101196","url":null,"abstract":"<div><div>Perinephric myxoid pseudotumor of fat (PMPF) is a rare and highly heterogeneous disease consisting of mature fat, myxoid stroma with spindled or stellate stromal cells histologically. Here, we present 2 cases of PMPF occurring in an allograft and a native kidney, and a systematic review that included 120 previously reported cases was subsequently conducted. Notably, 89% of PMPF cases with documented medical history had comorbidities. The most common comorbidities were urologic neoplasm (45%), chronic kidney disease (23%), allograft kidney (16%), and urinary tract obstruction (5%). We propose a classification of PMPF based on comorbidities and discovered that patients with concomitant urologic neoplasm or obstruction tended to have significantly smaller tumors, and active surveillance of PMPF after treating the primary disease might be an appropriate approach. In contrast, for patients with kidney transplants, chronic kidney disease, or no identifiable primary disease, the tumors were generally larger; therefore, surgical intervention should be considered. Regardless of the classification method used, for tumors exhibiting a slow growth rate, active surveillance should be considered. Our findings aimed to facilitate more accurate differential diagnosis and optimize treatment options.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101196"},"PeriodicalIF":3.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-16DOI: 10.1016/j.xkme.2025.101222
Kelcie K. Darpel , Julie A. Wright-Nunes , Sarah T. Hawley , Michelle A. Hladunewich , Claire Z. Kalpakjian , Corey Powell , Andrea L. Oliverio
<div><h3>Rationale & Objective</h3><div>Female reproductive health is affected by kidney disease but is often not addressed in nephrology care. Our objective was to better understand patient education needs on this topic to facilitate reproductive health education and care in chronic kidney disease (CKD).</div></div><div><h3>Study Design</h3><div>A cross-sectional online survey.</div></div><div><h3>Setting & Participants</h3><div>Female assigned sex at birth, aged 18-45 years, within the United States, fluent in English, with CKD recruited from national kidney organizations, research consortiums, and an academic medical center.</div></div><div><h3>Outcomes</h3><div>Reproductive health knowledge satisfaction, education needs, and communication preferences and barriers.</div></div><div><h3>Exposures</h3><div>Gravidity, pregnancy planning, CKD stage, disease etiology, health literacy, and demographics.</div></div><div><h3>Analytic Approach</h3><div>Univariate and multivariable logistic regression were used to examine associations between patient characteristics, knowledge satisfaction, and education needs. Descriptive statistics were used to assess communication preferences and barriers.</div></div><div><h3>Results</h3><div>Two hundred and nine surveys were completed. In total, 77% of participants self-identified as White, 11% Black, 4% Asian, and 11% Hispanic. A total of 23% had limited health literacy. Individuals planning a pregnancy in the future had lower knowledge satisfaction in univariate analysis. After multivariable analysis, only health literacy was significantly associated with knowledge satisfaction (<em>β</em>, −0.5; 95% CI, −0.9 to −0.02; <em>P</em> = 0.04). Understanding the impact of CKD on fetal development and menstruation, and kidney function changes after pregnancy were topics ranked as high priority by patients. Most wanted a nephrologist’s recommendation about birth control (76%; n = 159/209) and pregnancy timing (77%; n = 161/209).</div></div><div><h3>Limitations</h3><div>The limitations include convenience sampling and generalizability because of the online delivery of the survey and overrepresentation of higher socioeconomic groups.</div></div><div><h3>Conclusions</h3><div>This study provides priority topics to include in pregnancy planning during CKD care. Patients want advice from their nephrologists. More tools are needed to support reproductive health education for people with CKD, starting by addressing the need for those with limited health literacy.</div></div><div><h3>Plain-language Summary</h3><div>Chronic kidney disease (CKD) presents reproductive health challenges that can affect both the mother and fetus. Our study surveyed 209 women with CKD to assess their current reproductive health knowledge satisfaction, educational needs, and communication preferences and barriers. Results revealed that women are not satisfied with their knowledge about the effects of CKD on reproductive health, especially for thos
{"title":"Reproductive Health Knowledge and Educational Priorities in Chronic Kidney Disease: A Cross-Sectional Survey of People With CKD","authors":"Kelcie K. Darpel , Julie A. Wright-Nunes , Sarah T. Hawley , Michelle A. Hladunewich , Claire Z. Kalpakjian , Corey Powell , Andrea L. Oliverio","doi":"10.1016/j.xkme.2025.101222","DOIUrl":"10.1016/j.xkme.2025.101222","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Female reproductive health is affected by kidney disease but is often not addressed in nephrology care. Our objective was to better understand patient education needs on this topic to facilitate reproductive health education and care in chronic kidney disease (CKD).</div></div><div><h3>Study Design</h3><div>A cross-sectional online survey.</div></div><div><h3>Setting & Participants</h3><div>Female assigned sex at birth, aged 18-45 years, within the United States, fluent in English, with CKD recruited from national kidney organizations, research consortiums, and an academic medical center.</div></div><div><h3>Outcomes</h3><div>Reproductive health knowledge satisfaction, education needs, and communication preferences and barriers.</div></div><div><h3>Exposures</h3><div>Gravidity, pregnancy planning, CKD stage, disease etiology, health literacy, and demographics.</div></div><div><h3>Analytic Approach</h3><div>Univariate and multivariable logistic regression were used to examine associations between patient characteristics, knowledge satisfaction, and education needs. Descriptive statistics were used to assess communication preferences and barriers.</div></div><div><h3>Results</h3><div>Two hundred and nine surveys were completed. In total, 77% of participants self-identified as White, 11% Black, 4% Asian, and 11% Hispanic. A total of 23% had limited health literacy. Individuals planning a pregnancy in the future had lower knowledge satisfaction in univariate analysis. After multivariable analysis, only health literacy was significantly associated with knowledge satisfaction (<em>β</em>, −0.5; 95% CI, −0.9 to −0.02; <em>P</em> = 0.04). Understanding the impact of CKD on fetal development and menstruation, and kidney function changes after pregnancy were topics ranked as high priority by patients. Most wanted a nephrologist’s recommendation about birth control (76%; n = 159/209) and pregnancy timing (77%; n = 161/209).</div></div><div><h3>Limitations</h3><div>The limitations include convenience sampling and generalizability because of the online delivery of the survey and overrepresentation of higher socioeconomic groups.</div></div><div><h3>Conclusions</h3><div>This study provides priority topics to include in pregnancy planning during CKD care. Patients want advice from their nephrologists. More tools are needed to support reproductive health education for people with CKD, starting by addressing the need for those with limited health literacy.</div></div><div><h3>Plain-language Summary</h3><div>Chronic kidney disease (CKD) presents reproductive health challenges that can affect both the mother and fetus. Our study surveyed 209 women with CKD to assess their current reproductive health knowledge satisfaction, educational needs, and communication preferences and barriers. Results revealed that women are not satisfied with their knowledge about the effects of CKD on reproductive health, especially for thos","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101222"},"PeriodicalIF":3.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-16DOI: 10.1016/j.xkme.2025.101229
Alexander S. Misono , Tust Techasith , Avinash Mesipam , Trushar Patel , Christopher Baker , Behroz Oftadeh , Vincent Nguyen , Quan Dang , Lindsey Young , Thomas Velling
Percutaneous kidney biopsies, including coaxial needle biopsy (CNB), have become the preferred method for obtaining tissue samples to supplement laboratory and imaging data in diagnosing or characterizing various renal conditions. Despite the advent of intraprocedural computed tomography scans or ultrasound image guidance, as well as various “plugging” techniques, bleeding remains a frequent and potentially highly morbid complication, particularly in patients with bleeding risks. As such, postbiopsy bleeding is also a primary driver of extended patient monitoring and, in significant cases, results in additional imaging, intervention, and even surgery. Death, although very rare, also occurs.
We reported a series of 5 image-guided kidney biopsy cases that used a new electrocautery hemostasis device called SinglePass Kronos for hemostasis and tract closure. All biopsy procedures were successful, and there were no complications through 30 days following CNB. Postprocedure imaging confirmed the absence of bleeding in all 5 cases.
The SinglePass Kronos device is a potentially valuable tool in minimizing bleeding complications in percutaneous solid organ biopsy procedures and has particular utility in high-risk biopsies such as kidney biopsies. Larger-scale studies of this new device may be warranted.
{"title":"SinglePass Kronos Electrocautery Device for Closure After Percutaneous Medical Kidney Biopsy: A Series of Five Case Reports","authors":"Alexander S. Misono , Tust Techasith , Avinash Mesipam , Trushar Patel , Christopher Baker , Behroz Oftadeh , Vincent Nguyen , Quan Dang , Lindsey Young , Thomas Velling","doi":"10.1016/j.xkme.2025.101229","DOIUrl":"10.1016/j.xkme.2025.101229","url":null,"abstract":"<div><div>Percutaneous kidney biopsies, including coaxial needle biopsy (CNB), have become the preferred method for obtaining tissue samples to supplement laboratory and imaging data in diagnosing or characterizing various renal conditions. Despite the advent of intraprocedural computed tomography scans or ultrasound image guidance, as well as various “plugging” techniques, bleeding remains a frequent and potentially highly morbid complication, particularly in patients with bleeding risks. As such, postbiopsy bleeding is also a primary driver of extended patient monitoring and, in significant cases, results in additional imaging, intervention, and even surgery. Death, although very rare, also occurs.</div><div>We reported a series of 5 image-guided kidney biopsy cases that used a new electrocautery hemostasis device called SinglePass Kronos for hemostasis and tract closure. All biopsy procedures were successful, and there were no complications through 30 days following CNB. Postprocedure imaging confirmed the absence of bleeding in all 5 cases.</div><div>The SinglePass Kronos device is a potentially valuable tool in minimizing bleeding complications in percutaneous solid organ biopsy procedures and has particular utility in high-risk biopsies such as kidney biopsies. Larger-scale studies of this new device may be warranted.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101229"},"PeriodicalIF":3.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-16DOI: 10.1016/j.xkme.2025.101225
Gashu Ayehu , Michelle Vanessa Aguirre Polo , Yihe Yang , Ming Wu , Kenar D. Jhaveri
Fibrillary glomerulonephritis (FGN) is a rare glomerular disease characterized by the deposition of nonamyloid, typically Congo red-negative fibrils within the glomerular basement membrane and mesangium. Although the pathogenesis of FGN remains incompletely understood, several autoimmune conditions have been associated with its development, including systemic lupus erythematosus (SLE). The co-occurrence of SLE and FGN is rare, and the underlying pathophysiologic link, if any, remains poorly understood. We report 2 cases of biopsy-proven FGN with positive DnaJ homolog subfamily B member 9 (DNAJB9) immunostaining in patients with established SLE, one with concurrent membranous lupus nephritis (LN) and the other without LN. Both patients were treated with rituximab, achieving complete proteinuria remission with preserved kidney function in one case and improved creatinine levels in the other. Three cases of SLE-associated FGN with positive DNAJB9 staining have been previously reported. Two others have been described as such, but without documentation of relevant clinical details such as DNAJB9 status, making them unsuitable for the current discussion. Our cases add to the literature supporting a potential association between SLE and FGN and represent the first published evidence of the safety and efficacy of rituximab in this rare condition.
{"title":"Fibrillary Glomerulonephritis in Systemic Lupus Erythematosus: A Case Series","authors":"Gashu Ayehu , Michelle Vanessa Aguirre Polo , Yihe Yang , Ming Wu , Kenar D. Jhaveri","doi":"10.1016/j.xkme.2025.101225","DOIUrl":"10.1016/j.xkme.2025.101225","url":null,"abstract":"<div><div>Fibrillary glomerulonephritis (FGN) is a rare glomerular disease characterized by the deposition of nonamyloid, typically Congo red-negative fibrils within the glomerular basement membrane and mesangium. Although the pathogenesis of FGN remains incompletely understood, several autoimmune conditions have been associated with its development, including systemic lupus erythematosus (SLE). The co-occurrence of SLE and FGN is rare, and the underlying pathophysiologic link, if any, remains poorly understood. We report 2 cases of biopsy-proven FGN with positive DnaJ homolog subfamily B member 9 (DNAJB9) immunostaining in patients with established SLE, one with concurrent membranous lupus nephritis (LN) and the other without LN. Both patients were treated with rituximab, achieving complete proteinuria remission with preserved kidney function in one case and improved creatinine levels in the other. Three cases of SLE-associated FGN with positive DNAJB9 staining have been previously reported. Two others have been described as such, but without documentation of relevant clinical details such as DNAJB9 status, making them unsuitable for the current discussion. Our cases add to the literature supporting a potential association between SLE and FGN and represent the first published evidence of the safety and efficacy of rituximab in this rare condition.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101225"},"PeriodicalIF":3.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We describe a case of 70-year-old man with type 2 diabetes and myelodysplastic syndrome progressing to acute myeloid leukemia (AML) who presented with rapidly worsening kidney function. Although computed tomography imaging of the patient’s kidneys was unremarkable, subsequent magnetic resonance imaging (MRI) showed high signal intensity on diffusion-weighted imaging and low signal intensity on the apparent diffusion coefficient map in the kidneys. A kidney biopsy from the region that exhibited abnormal findings on MRI showed blast cell infiltration within the kidney capsule and proximal tubules. After initiating venetoclax and azacitidine therapy, the patient’s AML promptly improved, and his kidney function rapidly recovered. Kidney infiltration in AML is rare and difficult to diagnose because of nonspecific symptoms and the limited sensitivity of plain computed tomography. This case highlights the value of MRI, especially diffusion-weighted imaging and apparent diffusion coefficient mapping, for the detection of blast cell infiltration in the kidneys. To our knowledge, this is the first case in which kidney infiltration was identified in a patient with AML based on imaging findings. This case supports the consideration of MRI as a noninvasive diagnostic tool in patients with unexplained kidney dysfunction and hematologic malignancies.
{"title":"Diffusion-Weighted Magnetic Resonance Imaging and Apparent Diffusion Coefficient Mapping Detect Kidney Infiltration in Acute Myeloid Leukemia: A Case Report","authors":"Yusuke Yoshimura , Yuki Oba , Kei Kono , Hisashi Yamamoto , Hisashi Kamido , Hisashi Sugimoto , Shigekazu Kurihara , Masayuki Yamanouchi , Tatsuya Suwabe , Kenichi Ohashi , Yoshifumi Ubara , Naoki Sawa","doi":"10.1016/j.xkme.2025.101226","DOIUrl":"10.1016/j.xkme.2025.101226","url":null,"abstract":"<div><div>We describe a case of 70-year-old man with type 2 diabetes and myelodysplastic syndrome progressing to acute myeloid leukemia (AML) who presented with rapidly worsening kidney function. Although computed tomography imaging of the patient’s kidneys was unremarkable, subsequent magnetic resonance imaging (MRI) showed high signal intensity on diffusion-weighted imaging and low signal intensity on the apparent diffusion coefficient map in the kidneys. A kidney biopsy from the region that exhibited abnormal findings on MRI showed blast cell infiltration within the kidney capsule and proximal tubules. After initiating venetoclax and azacitidine therapy, the patient’s AML promptly improved, and his kidney function rapidly recovered. Kidney infiltration in AML is rare and difficult to diagnose because of nonspecific symptoms and the limited sensitivity of plain computed tomography. This case highlights the value of MRI, especially diffusion-weighted imaging and apparent diffusion coefficient mapping, for the detection of blast cell infiltration in the kidneys. To our knowledge, this is the first case in which kidney infiltration was identified in a patient with AML based on imaging findings. This case supports the consideration of MRI as a noninvasive diagnostic tool in patients with unexplained kidney dysfunction and hematologic malignancies.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101226"},"PeriodicalIF":3.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15DOI: 10.1016/j.xkme.2025.101218
Swetha R. Kanduri , Pooja Amarapurkar , Mohamed Hassanein , Sabine Karam , Juan Carlos Q. Velez , Kenar D. Jhaveri
Hypercalcemia can affect multiple organ systems and, depending on its severity, presents with a wide range of clinical manifestations. Severe hypercalcemia may lead to serious complications such as confusion and encephalopathy. Malignancy-associated hypercalcemia (MAH) occurs in up to 10%-30% of patients with cancer, with a higher incidence in those with advanced disease, and is associated with a poor prognosis. Several mechanisms have been proposed to explain MAH, the most prominent being humoral hypercalcemia of malignancy and osteolytic hypercalcemia. Although less common, recent advances have identified additional mechanisms of MAH, including novel cancer medications such as immune checkpoint inhibitors and prolonged immobilization. While various treatment modalities are available for managing hypercalcemia, dosing of antihypercalcemic medications in patients with kidney dysfunction remains challenging. This comprehensive review illustrates the mechanisms of MAH, discusses relevant investigations, and focuses on management strategies tailored to the severity of hypercalcemia in patients with cancer. Additionally, we address the dose adjustments for antihypercalcemic agents in patients with reduced glomerular filtration rate and explore potential areas for developing targeted therapies to better address MAH.
{"title":"Malignancy-Associated Hypercalcemia and Kidney Disease: Facts, Controversies, and Management","authors":"Swetha R. Kanduri , Pooja Amarapurkar , Mohamed Hassanein , Sabine Karam , Juan Carlos Q. Velez , Kenar D. Jhaveri","doi":"10.1016/j.xkme.2025.101218","DOIUrl":"10.1016/j.xkme.2025.101218","url":null,"abstract":"<div><div>Hypercalcemia can affect multiple organ systems and, depending on its severity, presents with a wide range of clinical manifestations. Severe hypercalcemia may lead to serious complications such as confusion and encephalopathy. Malignancy-associated hypercalcemia (MAH) occurs in up to 10%-30% of patients with cancer, with a higher incidence in those with advanced disease, and is associated with a poor prognosis. Several mechanisms have been proposed to explain MAH, the most prominent being humoral hypercalcemia of malignancy and osteolytic hypercalcemia. Although less common, recent advances have identified additional mechanisms of MAH, including novel cancer medications such as immune checkpoint inhibitors and prolonged immobilization. While various treatment modalities are available for managing hypercalcemia, dosing of antihypercalcemic medications in patients with kidney dysfunction remains challenging. This comprehensive review illustrates the mechanisms of MAH, discusses relevant investigations, and focuses on management strategies tailored to the severity of hypercalcemia in patients with cancer. Additionally, we address the dose adjustments for antihypercalcemic agents in patients with reduced glomerular filtration rate and explore potential areas for developing targeted therapies to better address MAH.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101218"},"PeriodicalIF":3.4,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15DOI: 10.1016/j.xkme.2025.101217
Sebastian Mussnig , Luis Naar , Simon Krenn , Florian Brosch , Daniel Schneditz , Joachim Beige , Manfred Hecking
<div><h3>Rationale & Objective</h3><div>Fluid management in hemodialysis aims to remove excess fluid while avoiding symptoms of fluid depletion. This study evaluated the impact of determining euvolemic body mass by bioimpedance spectroscopy, and absolute blood volume (ABV), on clinical practice and patient-reported outcome measures (PROMs) at a bioimpedance/ABV-naïve dialysis center.</div></div><div><h3>Study Design</h3><div>Fourteen week quality improvement project with 3 Assessment phases separated by 2 Adjustment phases.</div></div><div><h3>Setting & Participants</h3><div>Total of 127 patients at a single dialysis center.</div></div><div><h3>Quality Improvement Activities</h3><div>Bioimpedance-spectroscopy-derived fluid overload (FO), ABV, and PROMs were longitudinally recorded. Physicians received data from each Assessment phase to inform treatment decisions.</div></div><div><h3>Outcomes</h3><div>Fluid overload, ABV, PROMs, and agreement between perceived fluid status and FO.</div></div><div><h3>Analytic Approach</h3><div>Generalized linear mixed-effects models analyzed changes over time and associations between FO, ABV, and PROMs. Agreement between perceived fluid status and FO was evaluated with linearly weighted Cohen’s κ.</div></div><div><h3>Results</h3><div>With each Assessment phase, pre-dialysis FO, systolic and diastolic blood pressure decreased overall (−0.12 L, <em>P</em> = 0.006; −1.43 mm Hg, <em>P</em> = 0.003; −0.83 mm Hg, <em>P</em> < 0.001), with a stronger reduction in baseline fluid overloaded (FO relative to extracellular fluid >15%) patients (−0.25 L, <em>P</em> < 0.001; −1.84 mm Hg, <em>P</em> = 0.011; −1.18 mm Hg, <em>P</em> = 0.01). The difference between post-dialysis and euvolemic body mass decreased in fluid overloaded patients (−0.19 kg, <em>P</em> = 0.006). Odds of longer recovery time increased (1.43, <em>P</em> = 0.017), but no significant changes in intradialytic complications or hypotension occurred, and FO and ABV were not associated with any PROM (including recovery time) overall and separately in fluid overloaded patients. Agreement between perceived and bioimpedance-spectroscopy-derived FO was poor (κ: 0.007-0.037 for patients, 0.022-0.018 for nurses).</div></div><div><h3>Conclusions</h3><div>During the introduction of bioimpedance- and ABV-guided fluid management at a hemodialysis center, fluid status improved without significant changes in intradialytic morbid events. The lack of agreement between perceived fluid status and bioimpedance-spectroscopy-derived FO reflects the daily clinical struggle when negotiating fluid management based on objective measures.</div></div><div><h3>Plain-language Summary</h3><div>Hemodialysis allows to remove excess fluid in patients with impaired kidney function who produce little-to-no urine. Closely monitoring fluid status is necessary to minimize both fluid depletion and fluid overload. This study investigated the combination of objective and subjective mo
目的血液透析中液体管理的目的是去除多余的液体，同时避免出现液体耗竭的症状。在生物阻抗/ABV-naïve透析中心，本研究评估了通过生物阻抗光谱和绝对血容量（ABV）测定euvolemic体质量对临床实践和患者报告的结果测量（PROMs）的影响。研究设计：为期14周的质量改进项目，分为3个评估阶段和2个调整阶段。对象：单个透析中心共127例患者。质量改进活动生物阻抗光谱衍生的流体过载（FO）， ABV和prom进行了纵向记录。医生收到每个评估阶段的数据，以告知治疗决策。结果：流体过载，ABV, PROMs，以及感知流体状态和FO之间的一致性。广义线性混合效应模型分析了FO、ABV和prom之间随时间的变化和关联。用线性加权Cohen’s κ评价感知流体状态与FO之间的一致性。结果在每个评估阶段，透析前FO、收缩压和舒张压总体下降（- 0.12 L, P = 0.006; - 1.43 mm Hg, P = 0.003; - 0.83 mm Hg, P = 0.001），基线液体负荷（相对于细胞外液的FO >；15%）患者的降低幅度更大（- 0.25 L, P < 0.001; - 1.84 mm Hg, P = 0.011; - 1.18 mm Hg, P = 0.01）。液体超载患者透析后和大容量体质量之间的差异减小（- 0.19 kg, P = 0.006）。较长恢复时间的几率增加（1.43,P = 0.017），但透析内并发症或低血压的发生没有显著变化，液体超载患者的FO和ABV与整体和单独的任何PROM（包括恢复时间）无关。感知FO与生物阻抗光谱衍生FO之间的一致性较差（患者κ: 0.007-0.037，护士κ: 0.022-0.018）。结论在血液透析中心引入生物阻抗和abv引导的液体管理后，液体状态得到改善，但透析内疾病事件没有明显变化。感知到的流体状态和生物阻抗光谱衍生的FO之间缺乏一致性反映了在基于客观测量的流体管理谈判时的日常临床斗争。简单的语言总结血液透析允许排除多余的液体患者肾功能受损产生很少或没有尿。密切监测流体状态是必要的，以尽量减少流体耗尽和流体过载。本研究通过透析中心为期14周的质量改善项目，调查了客观和主观模式的结合，以告知治疗决策。通过引入两种体液状态的客观评估（生物阻抗谱和绝对血容量），再加上关于患者主观健康的重复数字问卷，体液状态得到了显著改善。有趣的是，患者和护士对液体超载的主观感知与客观发现并不一致。在与患者协商液体管理时，可能需要在包容性环境中结合客观和主观措施。
{"title":"Fluid Management Based on Bioimpedance, Blood Volume, and Patient Reports: A Quality Improvement Project in Maintenance Hemodialysis","authors":"Sebastian Mussnig , Luis Naar , Simon Krenn , Florian Brosch , Daniel Schneditz , Joachim Beige , Manfred Hecking","doi":"10.1016/j.xkme.2025.101217","DOIUrl":"10.1016/j.xkme.2025.101217","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Fluid management in hemodialysis aims to remove excess fluid while avoiding symptoms of fluid depletion. This study evaluated the impact of determining euvolemic body mass by bioimpedance spectroscopy, and absolute blood volume (ABV), on clinical practice and patient-reported outcome measures (PROMs) at a bioimpedance/ABV-naïve dialysis center.</div></div><div><h3>Study Design</h3><div>Fourteen week quality improvement project with 3 Assessment phases separated by 2 Adjustment phases.</div></div><div><h3>Setting & Participants</h3><div>Total of 127 patients at a single dialysis center.</div></div><div><h3>Quality Improvement Activities</h3><div>Bioimpedance-spectroscopy-derived fluid overload (FO), ABV, and PROMs were longitudinally recorded. Physicians received data from each Assessment phase to inform treatment decisions.</div></div><div><h3>Outcomes</h3><div>Fluid overload, ABV, PROMs, and agreement between perceived fluid status and FO.</div></div><div><h3>Analytic Approach</h3><div>Generalized linear mixed-effects models analyzed changes over time and associations between FO, ABV, and PROMs. Agreement between perceived fluid status and FO was evaluated with linearly weighted Cohen’s κ.</div></div><div><h3>Results</h3><div>With each Assessment phase, pre-dialysis FO, systolic and diastolic blood pressure decreased overall (−0.12 L, <em>P</em> = 0.006; −1.43 mm Hg, <em>P</em> = 0.003; −0.83 mm Hg, <em>P</em> < 0.001), with a stronger reduction in baseline fluid overloaded (FO relative to extracellular fluid >15%) patients (−0.25 L, <em>P</em> < 0.001; −1.84 mm Hg, <em>P</em> = 0.011; −1.18 mm Hg, <em>P</em> = 0.01). The difference between post-dialysis and euvolemic body mass decreased in fluid overloaded patients (−0.19 kg, <em>P</em> = 0.006). Odds of longer recovery time increased (1.43, <em>P</em> = 0.017), but no significant changes in intradialytic complications or hypotension occurred, and FO and ABV were not associated with any PROM (including recovery time) overall and separately in fluid overloaded patients. Agreement between perceived and bioimpedance-spectroscopy-derived FO was poor (κ: 0.007-0.037 for patients, 0.022-0.018 for nurses).</div></div><div><h3>Conclusions</h3><div>During the introduction of bioimpedance- and ABV-guided fluid management at a hemodialysis center, fluid status improved without significant changes in intradialytic morbid events. The lack of agreement between perceived fluid status and bioimpedance-spectroscopy-derived FO reflects the daily clinical struggle when negotiating fluid management based on objective measures.</div></div><div><h3>Plain-language Summary</h3><div>Hemodialysis allows to remove excess fluid in patients with impaired kidney function who produce little-to-no urine. Closely monitoring fluid status is necessary to minimize both fluid depletion and fluid overload. This study investigated the combination of objective and subjective mo","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101217"},"PeriodicalIF":3.4,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15DOI: 10.1016/j.xkme.2025.101221
Mary F. Hannan , Michael J. Fischer , Jesse Hsu , Alana D. Steffen , Feiyi Sun , Kerri L. Cavanaugh , Laura M. Dember , John Farrar , Manisha Jhamb , Paul L. Kimmel , Mark B. Lockwood , Sagar U. Nigwekar , Rebecca Schmidt , Jennifer L. Steel , Mark Unruh , Ardith Z. Doorenbos
<div><h3>Rationale & Objective</h3><div>Fatigue is commonly experienced by adults with kidney failure receiving hemodialysis and those with chronic pain, but factors associated with fatigue are not fully understood. We determined the prevalence of fatigue in a clinical trial cohort of adults receiving maintenance hemodialysis who have chronic pain and identified factors associated with fatigue.</div></div><div><h3>Study Design</h3><div>A cross-sectional study.</div></div><div><h3>Setting & Participants</h3><div>The baseline data from the HOPE Consortium Trial to Reduce Pain and Opioid Use in Hemodialysis (HOPE Trial). Of the 643 participants randomized in the HOPE Trial, 636 had a baseline fatigue assessment and were included in this study.</div></div><div><h3>Exposures</h3><div>Pain, sociodemographic, biological, dialysis-related, medical comorbid condition, psychological, and behavioral factors.</div></div><div><h3>Outcome</h3><div>Fatigue was evaluated with the patient-reported outcomes measurement information system Fatigue SF 6a and defined as a T-score of ≥ 55.</div></div><div><h3>Analytical Approach</h3><div>Logistic regression models.</div></div><div><h3>Results</h3><div>Seventy-three percent of participants reported fatigue (n = 463), mean age was 60.4 (12.5), 289 (45.4%) were female, and 294 (46.2%) were Black/African American. In fully adjusted models, higher pain interference and opioid use in the last 14 days were each associated with higher odds of having fatigue (odds ratio ([OR) ] 1.37; 95% CI, 1.18-1.61; OR 1.80; 95% CI, 1.03-3.21, respectively), as were greater depressive symptoms and sleep disturbance (OR 1.21; 95% CI. 1.13-1.31; OR 1.08 95% CI 1.03-1.12, respectively). Higher physical function was associated with lower odds of having fatigue (OR 0.96 95% CI 0.93-0.99).</div></div><div><h3>Limitations</h3><div>Fatigue assessed at one point in time.</div></div><div><h3>Conclusions</h3><div>In adults receiving maintenance hemodialysis who have chronic pain, pain interference, opioid use, depression, and sleep disturbances are associated with increased odds of fatigue, and greater physical function is associated with lower odds of fatigue. Future work is needed to evaluate longitudinal associations, underlying mechanisms, and identify interventions.</div></div><div><h3>Plain-Language Summary</h3><div>Fatigue is commonly experienced by adults with kidney failure receiving hemodialysis and those with chronic pain, but factors associated with fatigue are not fully understood. Baseline data were examined from adults with kidney failure receiving hemodialysis who have chronic pain in the HOPE Trial. Fatigue was found in 73% of included participants. Higher levels of pain interference, opioid use, depressive symptoms, and sleep disturbances were each associated with higher odds of having fatigue. Higher levels of physical function were associated with lower odds of having fatigue. Future work is needed to evaluate causes of fati
理由和目的接受血液透析的肾功能衰竭和慢性疼痛的成年人通常会感到疲劳，但与疲劳相关的因素尚不完全清楚。我们在一组接受维持性血液透析且患有慢性疼痛的成人临床试验队列中确定了疲劳的患病率，并确定了与疲劳相关的因素。研究设计：横断面研究。背景和参与者：减少血液透析疼痛和阿片类药物使用的HOPE联合试验（HOPE试验）的基线数据。在HOPE试验中随机分配的643名参与者中，有636人进行了基线疲劳评估，并被纳入本研究。暴露：西班牙、社会人口统计学、生物学、透析相关、医学合并症、心理和行为因素。使用患者报告的结果测量信息系统Fatigue SF 6a评估疲劳，并将t评分定义为≥55。分析方法逻辑回归模型。结果73%的参与者报告疲劳（n = 463），平均年龄为60.4(12.5)，女性289(45.4%)，黑人/非裔美国人294（46.2%）。在完全调整后的模型中，在最后14天内，较高的疼痛干扰和阿片类药物使用均与较高的疲劳发生率相关(优势比[OR] 1.37；95% ci, 1.18-1.61；或1.80;95% CI分别为1.03-3.21)，更严重的抑郁症状和睡眠障碍也是如此(OR 1.21; 95% CI。1.13 - -1.31;OR 1.08 （95% CI 1.03-1.12）。较高的身体机能与较低的疲劳发生率相关（OR 0.96 95% CI 0.93-0.99）。限制疲劳评估在一个时间点。结论在接受维持性血液透析的成年人中，慢性疼痛、疼痛干扰、阿片类药物使用、抑郁和睡眠障碍与疲劳发生率增加相关，而身体功能增强与疲劳发生率降低相关。未来的工作需要评估纵向关联，潜在机制，并确定干预措施。接受血液透析的肾功能衰竭成人和慢性疼痛患者通常会感到疲劳，但与疲劳相关的因素尚不完全清楚。基线数据来自HOPE试验中接受血液透析的患有慢性疼痛的肾功能衰竭成人。73%的参与者感到疲劳。高水平的疼痛干扰、阿片类药物的使用、抑郁症状和睡眠障碍都与疲劳的高几率相关。身体机能水平越高，疲劳的几率就越低。未来的工作需要评估疲劳的原因，确定随着时间的推移导致疲劳的因素，并确定这一人群的疲劳干预措施。
{"title":"Risk Factors for Fatigue in Adults Receiving Maintenance Hemodialysis Who Have Chronic Pain: A Secondary Analysis of the HOPE Consortium Trial","authors":"Mary F. Hannan , Michael J. Fischer , Jesse Hsu , Alana D. Steffen , Feiyi Sun , Kerri L. Cavanaugh , Laura M. Dember , John Farrar , Manisha Jhamb , Paul L. Kimmel , Mark B. Lockwood , Sagar U. Nigwekar , Rebecca Schmidt , Jennifer L. Steel , Mark Unruh , Ardith Z. Doorenbos","doi":"10.1016/j.xkme.2025.101221","DOIUrl":"10.1016/j.xkme.2025.101221","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Fatigue is commonly experienced by adults with kidney failure receiving hemodialysis and those with chronic pain, but factors associated with fatigue are not fully understood. We determined the prevalence of fatigue in a clinical trial cohort of adults receiving maintenance hemodialysis who have chronic pain and identified factors associated with fatigue.</div></div><div><h3>Study Design</h3><div>A cross-sectional study.</div></div><div><h3>Setting & Participants</h3><div>The baseline data from the HOPE Consortium Trial to Reduce Pain and Opioid Use in Hemodialysis (HOPE Trial). Of the 643 participants randomized in the HOPE Trial, 636 had a baseline fatigue assessment and were included in this study.</div></div><div><h3>Exposures</h3><div>Pain, sociodemographic, biological, dialysis-related, medical comorbid condition, psychological, and behavioral factors.</div></div><div><h3>Outcome</h3><div>Fatigue was evaluated with the patient-reported outcomes measurement information system Fatigue SF 6a and defined as a T-score of ≥ 55.</div></div><div><h3>Analytical Approach</h3><div>Logistic regression models.</div></div><div><h3>Results</h3><div>Seventy-three percent of participants reported fatigue (n = 463), mean age was 60.4 (12.5), 289 (45.4%) were female, and 294 (46.2%) were Black/African American. In fully adjusted models, higher pain interference and opioid use in the last 14 days were each associated with higher odds of having fatigue (odds ratio ([OR) ] 1.37; 95% CI, 1.18-1.61; OR 1.80; 95% CI, 1.03-3.21, respectively), as were greater depressive symptoms and sleep disturbance (OR 1.21; 95% CI. 1.13-1.31; OR 1.08 95% CI 1.03-1.12, respectively). Higher physical function was associated with lower odds of having fatigue (OR 0.96 95% CI 0.93-0.99).</div></div><div><h3>Limitations</h3><div>Fatigue assessed at one point in time.</div></div><div><h3>Conclusions</h3><div>In adults receiving maintenance hemodialysis who have chronic pain, pain interference, opioid use, depression, and sleep disturbances are associated with increased odds of fatigue, and greater physical function is associated with lower odds of fatigue. Future work is needed to evaluate longitudinal associations, underlying mechanisms, and identify interventions.</div></div><div><h3>Plain-Language Summary</h3><div>Fatigue is commonly experienced by adults with kidney failure receiving hemodialysis and those with chronic pain, but factors associated with fatigue are not fully understood. Baseline data were examined from adults with kidney failure receiving hemodialysis who have chronic pain in the HOPE Trial. Fatigue was found in 73% of included participants. Higher levels of pain interference, opioid use, depressive symptoms, and sleep disturbances were each associated with higher odds of having fatigue. Higher levels of physical function were associated with lower odds of having fatigue. Future work is needed to evaluate causes of fati","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101221"},"PeriodicalIF":3.4,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15DOI: 10.1016/j.xkme.2025.101219
Shan Ma , Yanqing Hu , Yuanting Zhu , Shuaiye Liu , Yang Wu MD
<div><h3>Rationale & Objective</h3><div>Chronic kidney disease (CKD) is associated with a high risk of cardiovascular events. However, the role of diastolic blood pressure variability (DBPV) in predicting these outcomes, particularly in comparison to systolic blood pressure variability (SBPV), remains unclear. This study aimed to assess the prognostic value of DBPV in patients with CKD.</div></div><div><h3>Study Design</h3><div>A retrospective cohort study was conducted.</div></div><div><h3>Setting & Participants</h3><div>A total of 1,245 adults diagnosed with CKD (stages G3a, G3b, and G4-5) from the Seventh Affiliated Hospital of Sun Yat—sen University from 2019 to 2023 were included in the study.</div></div><div><h3>Exposures</h3><div>DBPV parameters, including 24-hour DBP standard deviation (SD), coefficient of variation, and nocturnal decline rate, were measured using 24-hour ambulatory blood pressure monitoring.</div></div><div><h3>Outcomes</h3><div>The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular death and heart failure hospitalization.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazards models were used to analyze the associations, adjusting for multiple confounding factors, such as SBP, SBPV, and traditional cardiovascular risk factors. Interaction analyses were performed by CKD stage. The incremental predictive value of DBPV was evaluated using integrated discrimination improvement and net reclassification improvement.</div></div><div><h3>Results</h3><div>During a median follow-up of 3.2 years, higher 24-hour DBP SD was independently associated with an increased risk of all-cause mortality (hazard ratio [HR], 1.08; 95% CI, 1.03-1.13; <em>P</em> = 0.002) and cardiovascular death (HR 1.11; 95% CI, 1.05-1.18; <em>P</em> < 0.001). A nondipping DBP pattern was associated with an increased risk of heart failure hospitalization (HR 1.42; 95% CI, 1.07-1.89; <em>P</em> = 0.02). These associations were more pronounced in patients with stage G4-5 CKD (eg, for all-cause mortality: HR 1.15; 95% CI, 1.08-1.23; <em>P</em> < 0.001). DBPV provided incremental prognostic value beyond SBPV (for cardiovascular death, integrated discrimination improvement = 0.023; <em>P</em> = 0.004).</div></div><div><h3>Limitations</h3><div>The study had a single-center design, lacked non-CKD and stage 1-2 CKD controls, and did not have longitudinal DBPV data.</div></div><div><h3>Conclusions</h3><div>DBPV independently predicts adverse cardiovascular outcomes in patients with CKD, with stronger associations in advanced stages. It adds incremental value to SBPV in predicting cardiovascular events in this high-risk population.</div></div><div><h3>Plain-Language Summary</h3><div>Chronic kidney disease (CKD) often leads to serious heart problems. However, we don't know much about how changes in diastolic blood pressure (the lower number in blood pressure readings) affect these risks. We studied over 1,20
理由和目的慢性肾脏疾病（CKD）与心血管事件的高风险相关。然而，舒张压变异性（DBPV）在预测这些结果中的作用，特别是与收缩压变异性（SBPV）相比，仍不清楚。本研究旨在评估DBPV在CKD患者中的预后价值。研究设计进行回顾性队列研究。研究对象2019年至2023年中山大学第七附属医院确诊为CKD （G3a、G3b和G4-5期）的1245名成人纳入研究。使用24小时动态血压监测测量dbpv参数，包括24小时DBP标准差（SD）、变异系数和夜间下降率。主要结果为全因死亡率。次要结局包括心血管死亡和心力衰竭住院。分析方法：采用cox比例风险模型分析相关性，调整多种混杂因素，如收缩压、SBPV和传统心血管危险因素。相互作用分析按CKD分期进行。采用综合判别改进和净重分类改进评价DBPV的增量预测值。结果在中位随访3.2年期间，较高的24小时DBP SD与全因死亡风险增加（风险比[HR]， 1.08; 95% CI, 1.03-1.13; P = 0.002）和心血管死亡风险增加（风险比[HR]， 1.11; 95% CI, 1.05-1.18; P < 0.001）独立相关。舒张压不下降与心力衰竭住院风险增加相关（HR 1.42; 95% CI, 1.07-1.89; P = 0.02）。这些关联在G4-5期CKD患者中更为明显（例如，全因死亡率：HR 1.15; 95% CI, 1.08-1.23; P < 0.001）。DBPV提供了比SBPV更大的预后价值（对于心血管死亡，综合判别改善= 0.023;P = 0.004）。该研究为单中心设计，缺乏非CKD和1-2期CKD对照，也没有纵向DBPV数据。结论dbpv独立预测CKD患者的不良心血管结局，在晚期有更强的相关性。它增加了SBPV在预测高危人群心血管事件中的增量价值。慢性肾脏疾病（CKD）经常导致严重的心脏问题。然而，我们对舒张压（血压读数中较低的数字）的变化如何影响这些风险知之甚少。我们研究了1200多名CKD患者，并使用24小时血压监测仪跟踪他们的舒张压波动（DBPV）。我们发现，高DBPV与更高的死亡、心脏相关死亡或因心力衰竭需要住院治疗的几率有关，尤其是在晚期CKD患者中。重要的是，这些波动给我们提供了比收缩压变化（上限）更多的风险信息。这意味着检查DBPV可以帮助医生更好地确定哪些CKD患者风险最高，需要额外的护理。
{"title":"Diastolic Blood Pressure Variability Predicts Cardiovascular Outcomes in CKD, Especially in Advanced Stages","authors":"Shan Ma , Yanqing Hu , Yuanting Zhu , Shuaiye Liu , Yang Wu MD","doi":"10.1016/j.xkme.2025.101219","DOIUrl":"10.1016/j.xkme.2025.101219","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Chronic kidney disease (CKD) is associated with a high risk of cardiovascular events. However, the role of diastolic blood pressure variability (DBPV) in predicting these outcomes, particularly in comparison to systolic blood pressure variability (SBPV), remains unclear. This study aimed to assess the prognostic value of DBPV in patients with CKD.</div></div><div><h3>Study Design</h3><div>A retrospective cohort study was conducted.</div></div><div><h3>Setting & Participants</h3><div>A total of 1,245 adults diagnosed with CKD (stages G3a, G3b, and G4-5) from the Seventh Affiliated Hospital of Sun Yat—sen University from 2019 to 2023 were included in the study.</div></div><div><h3>Exposures</h3><div>DBPV parameters, including 24-hour DBP standard deviation (SD), coefficient of variation, and nocturnal decline rate, were measured using 24-hour ambulatory blood pressure monitoring.</div></div><div><h3>Outcomes</h3><div>The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular death and heart failure hospitalization.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazards models were used to analyze the associations, adjusting for multiple confounding factors, such as SBP, SBPV, and traditional cardiovascular risk factors. Interaction analyses were performed by CKD stage. The incremental predictive value of DBPV was evaluated using integrated discrimination improvement and net reclassification improvement.</div></div><div><h3>Results</h3><div>During a median follow-up of 3.2 years, higher 24-hour DBP SD was independently associated with an increased risk of all-cause mortality (hazard ratio [HR], 1.08; 95% CI, 1.03-1.13; <em>P</em> = 0.002) and cardiovascular death (HR 1.11; 95% CI, 1.05-1.18; <em>P</em> < 0.001). A nondipping DBP pattern was associated with an increased risk of heart failure hospitalization (HR 1.42; 95% CI, 1.07-1.89; <em>P</em> = 0.02). These associations were more pronounced in patients with stage G4-5 CKD (eg, for all-cause mortality: HR 1.15; 95% CI, 1.08-1.23; <em>P</em> < 0.001). DBPV provided incremental prognostic value beyond SBPV (for cardiovascular death, integrated discrimination improvement = 0.023; <em>P</em> = 0.004).</div></div><div><h3>Limitations</h3><div>The study had a single-center design, lacked non-CKD and stage 1-2 CKD controls, and did not have longitudinal DBPV data.</div></div><div><h3>Conclusions</h3><div>DBPV independently predicts adverse cardiovascular outcomes in patients with CKD, with stronger associations in advanced stages. It adds incremental value to SBPV in predicting cardiovascular events in this high-risk population.</div></div><div><h3>Plain-Language Summary</h3><div>Chronic kidney disease (CKD) often leads to serious heart problems. However, we don't know much about how changes in diastolic blood pressure (the lower number in blood pressure readings) affect these risks. We studied over 1,20","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101219"},"PeriodicalIF":3.4,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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