Nefrologia最新文献

英文中文

Respuesta a la carta al editor «Sarcopenia: la importancia de las fórmulas» 对《Sarcopenia：公式的重要性》编辑信的答复

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-07-22 DOI: 10.1016/j.nefro.2025.501390

E. García-Menéndez, J. Portolés, A. Muñoz-Sánchez, A. Tato Ribera, C. Yuste Lozano, M. Ossorio González, P. López-Sánchez, D. Janeiro Marín

引用次数: 0

Factores que influyen en la depuración de toxinas urémicas unidas a proteínas en hemodiafiltración 影响血液滤过蛋白结合尿素毒素纯化的因素

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-07-22 DOI: 10.1016/j.nefro.2025.501391

Víctor Joaquín Escudero-Saiz , Elena Cuadrado-Payán , María Rodríguez-García , Gregori Casals , Lida María Rodas , Néstor Fontseré , José Jesús Broseta , Francisco Maduell

Introduction

Protein-bound uremic toxins (PBUTs) have a high affinity for albumin and they are associated with increased cardiovascular morbidity and mortality in hemodialysis patients. Among them, p-cresyl sulfate (pCS) and indoxyl sulfate (IS) stand out due to their high toxicity. Post-dilution hemodiafiltration (HDF) is one of the dialysis techniques that has shown the greatest benefits in terms of patient survival.

Materials and methods

This observational, single-center, cross-sectional study evaluated PBUT clearance in 137 patients undergoing post-dilution HDF, analyzing the factors that influence their removal. Reduction ratios (RRs) of IS and pCS were measured, as well as their correlation with dialysis parameters and clinical variables.

Results

The mean RR for IS was 53.4% ± 9.3%, and for pCS, 48.2% ± 11.3%. A significant correlation was observed between the RR of both toxins (r = 0.606; P < 0.01), suggesting similar elimination mechanisms. In addition, total convective volume showed a positive correlation with the RR of pCS (r = 0.19; P = 0.027) and a weak correlation with the RR of IS (r = 0.155; P = 0.07). A significant difference in clearance was found according to sex, with higher RRs in women (P < 0.001 for IS and P = 0.008 for pCS).

Conclusions

The clearance of PBUTs is primarily diffusive. Enhancing all variables related to this physical principle will improve the elimination of these toxins. Post-dilution HDF with high convective volume slightly increases this clearance. However, the results remain insufficient given the high toxicity of these molecules. New strategies, such as the use of adsorptive membranes and competitive molecules, are needed to optimize their removal and reduce the negative cardiovascular impact in hemodialysis patients.

蛋白结合尿毒症毒素（PBUTs）对白蛋白具有高亲和力，并且与血液透析患者心血管发病率和死亡率增加有关。其中，对甲酚硫酸盐（pCS）和吲哚酚硫酸盐（IS）因其高毒性而引人注目。稀释后血液滤过（HDF）是透析技术之一，在患者生存方面显示出最大的好处。材料和方法本观察性、单中心、横断面研究评估了137例稀释后HDF患者的PBUT清除情况，分析了影响清除的因素。测定IS和pCS的降低率（rr），并与透析参数和临床变量进行相关性分析。结果IS和pCS的平均RR分别为53.4%±9.3%和48.2%±11.3%。两种毒素的相对危险度呈显著相关（r = 0.606; P < 0.01），表明两种毒素的消除机制相似。总对流体积与pCS的RR呈正相关（r = 0.19, P = 0.027），与IS的RR呈弱相关（r = 0.155, P = 0.07）。根据性别发现清除率有显著差异，女性的rr较高（IS为P <； 0.001， pc为P = 0.008）。结论PBUTs的清除以弥漫性清除为主。加强与这一物理原理有关的所有变量将有助于消除这些毒素。高对流体积的稀释后HDF稍微增加了这个间隙。然而，考虑到这些分子的高毒性，结果仍然不够充分。需要新的策略，如使用吸附膜和竞争分子，来优化它们的去除并减少血液透析患者的负面心血管影响。

{"title":"Factores que influyen en la depuración de toxinas urémicas unidas a proteínas en hemodiafiltración","authors":"Víctor Joaquín Escudero-Saiz , Elena Cuadrado-Payán , María Rodríguez-García , Gregori Casals , Lida María Rodas , Néstor Fontseré , José Jesús Broseta , Francisco Maduell","doi":"10.1016/j.nefro.2025.501391","DOIUrl":"10.1016/j.nefro.2025.501391","url":null,"abstract":"<div><h3>Introduction</h3><div>Protein-bound uremic toxins (PBUTs) have a high affinity for albumin and they are associated with increased cardiovascular morbidity and mortality in hemodialysis patients. Among them, p-cresyl sulfate (pCS) and indoxyl sulfate (IS) stand out due to their high toxicity. Post-dilution hemodiafiltration (HDF) is one of the dialysis techniques that has shown the greatest benefits in terms of patient survival.</div></div><div><h3>Materials and methods</h3><div>This observational, single-center, cross-sectional study evaluated PBUT clearance in 137 patients undergoing post-dilution HDF, analyzing the factors that influence their removal. Reduction ratios (RRs) of IS and pCS were measured, as well as their correlation with dialysis parameters and clinical variables.</div></div><div><h3>Results</h3><div>The mean RR for IS was 53.4%±9.3%, and for pCS, 48.2%±11.3%. A significant correlation was observed between the RR of both toxins (<em>r</em>  <0.01), suggesting similar elimination mechanisms. In addition, total convective volume showed a positive correlation with the RR of pCS (<em>r</em>  =0.027) and a weak correlation with the RR of IS (<em>r</em>  =0.07). A significant difference in clearance was found according to sex, with higher RRs in women (<em>P</em>  =0.008 for pCS).</div></div><div><h3>Conclusions</h3><div>The clearance of PBUTs is primarily diffusive. Enhancing all variables related to this physical principle will improve the elimination of these toxins. Post-dilution HDF with high convective volume slightly increases this clearance. However, the results remain insufficient given the high toxicity of these molecules. New strategies, such as the use of adsorptive membranes and competitive molecules, are needed to optimize their removal and reduce the negative cardiovascular impact in hemodialysis patients.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 10","pages":"Article 501391"},"PeriodicalIF":2.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Experience with new anti-CD20 monoclonal antibodies for immune-mediated glomerulopathies in a tertiary hospital 新型抗cd20单克隆抗体在三级医院治疗免疫介导性肾小球疾病的经验

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-17 DOI: 10.1016/j.nefro.2025.501372

Jorge Iván Zamora , Marina López-Martínez , Natalia Ramos , Sheila Bermejo , Irene Agraz , Clara García-Carro , Marc Patricio , Juan Carlos León , Néstor Toapanta , Oriol Bestard , María José Soler

In the recent years, new humanized anti-CD20 monoclonal antibodies have been developed to optimize B-cell depletion. Our objective is to describe the experience at our center with the use of new anti-CD20 drugs in glomerular diseases. We included patients from our center treated with second-generation anti-CD20 monoclonal antibodies for glomerular diseases between January 2017 and January 2024. Patients were followed for one year after the initiation of treatment. Six patients were included, 2 (33%) men, with a median age of 59.5 (49–75) years. Diagnoses were 2 (33%) minimal change disease, 1 (16.7%) mixed cryoglobulinemia type-II, 1 (16.7%) membranous nephropathy, 1 (16.7%) fibrillary glomerulonephritis (FGN), and 1 (16.7%) focal segmental glomerulosclerosis. The indications for the new anti-CD20 therapy were 4 (66%) for refractory disease, 1 (16.7%) recurrent flares, and 1 (16.7%) due to an anaphylactic reaction to rituximab. The new anti-CD20 used were obinutuzumab in 4 (66%) and ofatumumab in 2 patients (33%). Before the start of the treatment median creatinine was 1.39 mg/dL (0.91–2.38) median serum albumin 2.7 g/dL [2.5–3.9 g/dL] and urine protein–creatinine ratio (UPCR) 5.75 g/g [2.38–4.85 g/g]. A total of 5 (83%) patients achieved partial/complete remission within the first 6 months of follow-up. By month twelve of the follow-up 4 (66.67%) patients remained with partial/complete remission. None of the patients had serious side effects. In conclusion, the use of new anti-CD20 therapies for the treatment of immune-mediated glomerular diseases is a safe and effective alternative for its treatment. Further research and clinical trials should be conducted to confirm these positive results.

近年来，新的人源抗cd20单克隆抗体被开发出来，以优化b细胞的消耗。我们的目的是描述我们中心在肾小球疾病中使用新的抗cd20药物的经验。我们纳入了2017年1月至2024年1月期间接受第二代抗cd20单克隆抗体治疗肾小球疾病的患者。患者在开始治疗后随访一年。纳入6例患者，2例（33%）男性，中位年龄59.5（49-75）岁。诊断为轻度病变2例（33%），混合型冷球蛋白血症1例（16.7%），膜性肾病1例（16.7%），纤维性肾小球肾炎（FGN） 1例（16.7%），局灶节段性肾小球硬化1例（16.7%）。新的抗cd20治疗的适应症为难治性疾病4例（66%），复发性耀斑1例（16.7%），利妥昔单抗过敏反应1例（16.7%）。新使用的抗cd20药物为4例（66%）的obinutuzumab和2例（33%）的ofatumumab。治疗开始前中位肌酐为1.39 mg/dL(0.91-2.38)，血清白蛋白中位2.7 g/dL [2.5-3.9 g/dL]，尿蛋白-肌酐比值（UPCR）为5.75 g/g [2.38-4.85 g/g]。在前6个月的随访中，共有5例（83%）患者达到部分/完全缓解。随访12个月时，4例（66.67%）患者保持部分/完全缓解。这些病人都没有严重的副作用。总之，使用新的抗cd20疗法治疗免疫介导的肾小球疾病是一种安全有效的治疗方案。应该进行进一步的研究和临床试验来证实这些积极的结果。

{"title":"Experience with new anti-CD20 monoclonal antibodies for immune-mediated glomerulopathies in a tertiary hospital","authors":"Jorge Iván Zamora , Marina López-Martínez , Natalia Ramos , Sheila Bermejo , Irene Agraz , Clara García-Carro , Marc Patricio , Juan Carlos León , Néstor Toapanta , Oriol Bestard , María José Soler","doi":"10.1016/j.nefro.2025.501372","DOIUrl":"10.1016/j.nefro.2025.501372","url":null,"abstract":"<div><div>In the recent years, new humanized anti-CD20 monoclonal antibodies have been developed to optimize B-cell depletion. Our objective is to describe the experience at our center with the use of new anti-CD20 drugs in glomerular diseases. We included patients from our center treated with second-generation anti-CD20 monoclonal antibodies for glomerular diseases between January 2017 and January 2024. Patients were followed for one year after the initiation of treatment. Six patients were included, 2 (33%) men, with a median age of 59.5 (49–75) years. Diagnoses were 2 (33%) minimal change disease, 1 (16.7%) mixed cryoglobulinemia type-II, 1 (16.7%) membranous nephropathy, 1 (16.7%) fibrillary glomerulonephritis (FGN), and 1 (16.7%) focal segmental glomerulosclerosis. The indications for the new anti-CD20 therapy were 4 (66%) for refractory disease, 1 (16.7%) recurrent flares, and 1 (16.7%) due to an anaphylactic reaction to rituximab. The new anti-CD20 used were obinutuzumab in 4 (66%) and ofatumumab in 2 patients (33%). Before the start of the treatment median creatinine was 1.39mg/dL (0.91–2.38) median serum albumin 2.7g/dL [2.5–3.9g/dL] and urine protein–creatinine ratio (UPCR) 5.75g/g [2.38–4.85g/g]. A total of 5 (83%) patients achieved partial/complete remission within the first 6 months of follow-up. By month twelve of the follow-up 4 (66.67%) patients remained with partial/complete remission. None of the patients had serious side effects. In conclusion, the use of new anti-CD20 therapies for the treatment of immune-mediated glomerular diseases is a safe and effective alternative for its treatment. Further research and clinical trials should be conducted to confirm these positive results.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 10","pages":"Article 501372"},"PeriodicalIF":2.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hacia una hemodiálisis sostenible: de la reflexión a la práctica 实现可持续血液透析：从思考到实践

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-16 DOI: 10.1016/j.nefro.2025.501368

Marta Arias-Guillén , M. Dolores Arenas , Claudia Yuste

引用次数: 0

Association of hemoglobin and red cell distribution width ratio with new cardiovascular events in peritoneal dialysis patients 腹膜透析患者血红蛋白和红细胞分布宽度比与新心血管事件的关系

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-14 DOI: 10.1016/j.nefro.2025.501370

Rong Wei , Wenying Zhang , Na Tian , Xiaojiang Zhan , Fenfen Peng , Xiaoyang Wang , Qingdong Xu , Ning Su , Juan Wu , Xingming Tang , Xiaoran Feng , Xianfeng Wu , Qian Zhou , Zhiyong Xie , Jianbo Liang , Yueqiang Wen

Objective

Peritoneal dialysis (PD) patients, who are more likely to have a poor prognosis for new cardiovascular events (CVE), are the focus of our research. We aim to investigate whether the hemoglobin-to-red cell distribution width (HRR) ratio is associated with a higher risk of new-onset CVE in PD patients. This research could potentially lead to new strategies for predicting and preventing new-onset CVE in PD patients.

Methods

One thousand four hundred seventy-four patients from November 1, 2005, to December 31, 2016, were divided into high and low HRR groups using restricted cubic spline (RCS). Various statistical methods were utilized to study the impact of HRR changes on new-onset CVE in PD patients, including Kaplan–Meier cumulative incidence curves, multivariate COX regression, competitive risk analysis, and forest plots to analyze subgroup interactions.

Results

During the follow-up period, 104 new-onset CVEs were recorded. Restricted cubic spline showed a non-linear relationship between HRR and new-onset CVE. A multifactorial COX regression analysis model showed reduced HRR as an independent risk factor for new-onset CVE (HR, 1.737; 95% CI 1.119–2.695, P = 0.014). Kaplan–Meier analysis showed a significant difference in survival between the two groups of patients (P = 0.002). The competing risks model found that after excluding endpoint events, there was still a significant difference in new-onset CVE (P = 0.0009) between the different HRR groups. In subgroup analyses, there were no significant differences between groups.

Conclusions

Low hemoglobin to red cell distribution width ratio (HRR) is associated with a higher risk of new-onset CVE in PD patients.

目的腹膜透析（PD）患者新发心血管事件（CVE）预后较差，是我们研究的重点。我们的目的是研究血红蛋白与红细胞分布宽度（HRR）比值是否与PD患者新发CVE的高风险相关。这项研究可能为预测和预防PD患者新发CVE提供新的策略。方法将2005年11月1日至2016年12月31日收治的1474例患者采用限制性三次样条法（RCS）分为高、低HRR组。采用Kaplan-Meier累积发病率曲线、多变量COX回归、竞争风险分析、森林图分析亚组相互作用等多种统计方法研究HRR变化对PD患者新发CVE的影响。结果随访期间共记录新发cve 104例。受限三次样条曲线显示HRR与新发CVE呈非线性关系。多因素COX回归分析模型显示，HRR降低是新发CVE的独立危险因素（HR, 1.737; 95% CI, 1.119-2.695, P = 0.014）。Kaplan-Meier分析显示两组患者的生存率有显著差异（P = 0.002）。竞争风险模型发现，在排除终点事件后，不同HRR组之间新发CVE仍有显著差异（P = 0.0009）。在亚组分析中，各组间无显著差异。结论慢血红蛋白与红细胞分布宽度比（HRR）与PD患者新发CVE风险增高有关。

{"title":"Association of hemoglobin and red cell distribution width ratio with new cardiovascular events in peritoneal dialysis patients","authors":"Rong Wei , Wenying Zhang , Na Tian , Xiaojiang Zhan , Fenfen Peng , Xiaoyang Wang , Qingdong Xu , Ning Su , Juan Wu , Xingming Tang , Xiaoran Feng , Xianfeng Wu , Qian Zhou , Zhiyong Xie , Jianbo Liang , Yueqiang Wen","doi":"10.1016/j.nefro.2025.501370","DOIUrl":"10.1016/j.nefro.2025.501370","url":null,"abstract":"<div><h3>Objective</h3><div>Peritoneal dialysis (PD) patients, who are more likely to have a poor prognosis for new cardiovascular events (CVE), are the focus of our research. We aim to investigate whether the hemoglobin-to-red cell distribution width (HRR) ratio is associated with a higher risk of new-onset CVE in PD patients. This research could potentially lead to new strategies for predicting and preventing new-onset CVE in PD patients.</div></div><div><h3>Methods</h3><div>One thousand four hundred seventy-four patients from November 1, 2005, to December 31, 2016, were divided into high and low HRR groups using restricted cubic spline (RCS). Various statistical methods were utilized to study the impact of HRR changes on new-onset CVE in PD patients, including Kaplan–Meier cumulative incidence curves, multivariate COX regression, competitive risk analysis, and forest plots to analyze subgroup interactions.</div></div><div><h3>Results</h3><div>During the follow-up period, 104 new-onset CVEs were recorded. Restricted cubic spline showed a non-linear relationship between HRR and new-onset CVE. A multifactorial COX regression analysis model showed reduced HRR as an independent risk factor for new-onset CVE (HR, 1.737; 95% CI 1.119–2.695, <em>P</em>  =0.002). The competing risks model found that after excluding endpoint events, there was still a significant difference in new-onset CVE (<em>P</em>  <!-->0.0009) between the different HRR groups. In subgroup analyses, there were no significant differences between groups.</div></div><div><h3>Conclusions</h3><div>Low hemoglobin to red cell distribution width ratio (HRR) is associated with a higher risk of new-onset CVE in PD patients.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 10","pages":"Article 501370"},"PeriodicalIF":2.6,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Increased serum phosphate concentration within the normal reference levels is associated with all-cause mortality in non-dialysis CKD patients: A five-year prospective cohort study 非透析慢性肾病患者血清磷酸盐浓度在正常参考水平内升高与全因死亡率相关：一项为期五年的前瞻性队列研究

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-13 DOI: 10.1016/j.nefro.2025.501352

Ana Cerqueira , Janete Quelhas-Santos , Núria Paulo , Claúdia Camila Dias , Manuel Pestana

Introduction and objectives

Cardiovascular (CV) morbidity and mortality are markedly increased in non-dialysis patients with chronic kidney disease (CKD). Thus, the precise management of CV risk factors involved in CKD is crucial to improving outcomes. Serum phosphate (Pi) and FGF-23 levels have been linked with a higher risk of CV events in CKD. However, the exact thresholds of Pi and FGF-23, at which the risk of adverse events increases remain unknown.

Materials and methods

We evaluated the expression of intact FGF-23 (iFGF-23) and Pi in a non-dialysis CKD patient population (n = 82; 42M:40F; median age 61 years) and investigated their association with CV and renal outcomes, in a five-year follow-up period.

Results

At baseline, the median estimated glomerular filtration rate (eGFR), iFGF-23, and Pi were 45 mL/min/1.73 m² (IQ 26.6–73.1), 69.9 μg/mL (IQ 33–117) and 3.4 mg/dL (IQ 3.3–3.9), respectively. Univariate analysis showed a strong association of both iFGF-23 and Pi with age, Charlson Comorbidity Index, hypertension, and diabetes. In addition, iFGF-23 and Pi were both associated with the composite outcome (major CV and cerebrovascular events – MACCEs, hospitalizations, and all-cause mortality) during follow-up. Moreover, Pi was independently associated with all-cause mortality during follow-up. The segmentation of the population in terciles, according to Pi (<3 mg/dL; 3–3.6 mg/dL; ≥3.7 mg/dL) within reference serum levels, showed a distribution of the fatality of 0%, 20% and 80% (p = 0.034), respectively.

Conclusions

Our results reinforce the association of both iFGF-23 and Pi with composite CV outcomes in non-dialysis CKD patients and further suggest that Pi, within current reference levels, may behave as an independent risk factor for mortality in this population. It is suggested that reassessing Pi reference levels for early therapeutic intervention in this population may be justified.

介绍和目的：慢性肾脏疾病（CKD）非透析患者的心血管（CV）发病率和死亡率显著增加。因此，精确管理CKD相关的心血管危险因素对改善预后至关重要。血清磷酸盐（Pi）和FGF-23水平与CKD中心血管事件的高风险相关。然而，不良事件风险增加的Pi和FGF-23的确切阈值仍然未知。材料和方法我们在一个非透析CKD患者群体（n = 82; 42M:40F；中位年龄61岁）中评估了完整的FGF-23 （iFGF-23）和Pi的表达，并在5年的随访期间研究了它们与CV和肾脏结局的关系。结果基线时，肾小球滤过率（eGFR）、iFGF-23和Pi的中位数分别为45 mL/min/1.73 m2 （IQ 26.6-73.1）、69.9 μg/mL （IQ 33-117）和3.4 mg/dL （IQ 3.3-3.9）。单因素分析显示，iFGF-23和Pi与年龄、Charlson合并症指数、高血压和糖尿病有很强的相关性。此外，在随访期间，iFGF-23和Pi均与复合结局（主要心血管和脑血管事件- MACCEs，住院和全因死亡率）相关。此外，Pi与随访期间的全因死亡率独立相关。根据参考血清水平内的Pi值（<3 mg/dL; 3 - 3.6 mg/dL;≥3.7 mg/dL）对种群进行分割，死亡率分布分别为0%、20%和80% （p = 0.034）。在非透析CKD患者中，研究结果强化了iFGF-23和Pi与复合CV结果的关联，并进一步表明Pi在当前参考水平范围内可能是该人群死亡的独立危险因素。因此，重新评估Pi参考水平对该人群进行早期治疗干预可能是合理的。

{"title":"Increased serum phosphate concentration within the normal reference levels is associated with all-cause mortality in non-dialysis CKD patients: A five-year prospective cohort study","authors":"Ana Cerqueira , Janete Quelhas-Santos , Núria Paulo , Claúdia Camila Dias , Manuel Pestana","doi":"10.1016/j.nefro.2025.501352","DOIUrl":"10.1016/j.nefro.2025.501352","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Cardiovascular (CV) morbidity and mortality are markedly increased in non-dialysis patients with chronic kidney disease (CKD). Thus, the precise management of CV risk factors involved in CKD is crucial to improving outcomes. Serum phosphate (Pi) and FGF-23 levels have been linked with a higher risk of CV events in CKD. However, the exact thresholds of Pi and FGF-23, at which the risk of adverse events increases remain unknown.</div></div><div><h3>Materials and methods</h3><div>We evaluated the expression of intact FGF-23 (iFGF-23) and Pi in a non-dialysis CKD patient population (<em>n</em>         =0.034), respectively.</div></div><div><h3>Conclusions</h3><div>Our results reinforce the association of both iFGF-23 and Pi with composite CV outcomes in non-dialysis CKD patients and further suggest that Pi, within current reference levels, may behave as an independent risk factor for mortality in this population. It is suggested that reassessing Pi reference levels for early therapeutic intervention in this population may be justified.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 9","pages":"Article 501352"},"PeriodicalIF":2.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145384311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sarcopenia: la importancia de las fórmulas 骨骼肌萎缩症：公式的重要性

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-12 DOI: 10.1016/j.nefro.2025.501367

José Ignacio Minguela Pesquera, Iñigo Moina Eguren

引用次数: 0

Hemodiálisis para seguir bailando 血液透析继续跳舞

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-12 DOI: 10.1016/j.nefro.2025.501366

Alba Santos García , Sandra Lizeth Castro Molano , Jose Andrés Meana

引用次数: 0

Posicionamiento sobre el manejo de la infección oculta por el virus B de la hepatitis (OBI) y anti-HBc+ en las unidades de hemodiálisis 血液透析单位对乙型肝炎隐性感染（OBI）和六氯环己烷+的管理采取的立场

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-11 DOI: 10.1016/j.nefro.2025.501355

Guillermina Barril Cuadrado , Ana Avellón Calvo , Elena Jiménez Vibora , Luisa García Buey , Rosa María Ruiz-Calero Cendrero , Antonio Cirugeda García , José Ibeas López , Cristina García Fernández , Federico García García , Roberto Alcázar Arroyo

引用次数: 0

Construction of risk factors and prediction model for arteriovenous graft thrombosis 动静脉移植物血栓形成危险因素及预测模型的建立

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-11 DOI: 10.1016/j.nefro.2025.501365

Yumei Fang, Xia Cao

Objective

This study aims to identify risk factors for thrombosis in arteriovenous grafts and construct a predictive model to assess thrombosis risk in patients undergoing maintenance hemodialysis (MHD).

Methods

A total of 160 MHD patients with arteriovenous graft were included and divided into a thrombosis group (n = 39) and a control group (n = 121). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. A nomogram prediction model was developed using R software, and its predictive performance was evaluated through calibration curves and C-index validation.

Results

Multivariate analysis identified diabetes, hypotension during dialysis, arteriovenous graft stenosis, compression hemostasis > 30 min, and calcium-phosphorus product > 55 mg²/dL² as independent risk factors for arteriovenous graft thrombosis. The nomogram model demonstrated good predictive accuracy, with an initial C-index of 0.753 and a validated C-index of 0.735.

Conclusion

The established nomogram effectively predicts arteriovenous graft thrombosis risk, aiding early identification and targeted intervention for high-risk patients.

目的探讨动静脉移植物血栓形成的危险因素，建立维持性血液透析（MHD）患者血栓形成的预测模型。方法160例MHD动静脉移植患者分为血栓组（n = 39）和对照组（n = 121）。进行单因素和多因素logistic回归分析以确定独立危险因素。利用R软件建立nomogram预测模型，并通过标定曲线和C-index验证对其预测性能进行评价。结果多因素分析发现，糖尿病、透析期间低血压、移植物动静脉狭窄、压迫止血30min、钙磷产物55mg2 /dL2是移植物动静脉血栓形成的独立危险因素。nomogram model具有较好的预测精度，初始C-index为0.753，验证C-index为0.735。结论建立的心电图能有效预测移植物动静脉血栓形成风险，有助于高危患者的早期识别和针对性干预。

{"title":"Construction of risk factors and prediction model for arteriovenous graft thrombosis","authors":"Yumei Fang, Xia Cao","doi":"10.1016/j.nefro.2025.501365","DOIUrl":"10.1016/j.nefro.2025.501365","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to identify risk factors for thrombosis in arteriovenous grafts and construct a predictive model to assess thrombosis risk in patients undergoing maintenance hemodialysis (MHD).</div></div><div><h3>Methods</h3><div>A total of 160 MHD patients with arteriovenous graft were included and divided into a thrombosis group (<em>n</em>  =121). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. A nomogram prediction model was developed using R software, and its predictive performance was evaluated through calibration curves and C-index validation.</div></div><div><h3>Results</h3><div>Multivariate analysis identified diabetes, hypotension during dialysis, arteriovenous graft stenosis, compression hemostasis>30min, and calcium-phosphorus product>55mg<sup>2</sup>/dL<sup>2</sup> as independent risk factors for arteriovenous graft thrombosis. The nomogram model demonstrated good predictive accuracy, with an initial C-index of 0.753 and a validated C-index of 0.735.</div></div><div><h3>Conclusion</h3><div>The established nomogram effectively predicts arteriovenous graft thrombosis risk, aiding early identification and targeted intervention for high-risk patients.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 10","pages":"Article 501365"},"PeriodicalIF":2.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Nefrologia

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀