Pub Date : 2025-06-04DOI: 10.1016/j.nefro.2025.501343
Pehuén Fernández , Facundo Schwarz , Emanuel José Saad , Walter Douthat , Javier De Arteaga , Jorge De La Fuente , Carlos Chiurchiu
{"title":"Dusseux score: A simple clinical tool to predict post-transplant mortality in elderly kidney recipients","authors":"Pehuén Fernández , Facundo Schwarz , Emanuel José Saad , Walter Douthat , Javier De Arteaga , Jorge De La Fuente , Carlos Chiurchiu","doi":"10.1016/j.nefro.2025.501343","DOIUrl":"10.1016/j.nefro.2025.501343","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 7","pages":"Article 501343"},"PeriodicalIF":2.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721736","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}
Pub Date : 2025-06-04DOI: 10.1016/j.nefro.2025.501336
Ali Ilter , Meric Oruc , Sukran Sarikaya Kayipmaz , Ergun Parmaksiz
Glomerulonephritis associated with celiac disease (CD) is rarely reported. Here we report a rare case of nephrotic syndrome associated with C3 glomerulopathy (C3G) in a patient with CD. A 19-year-old female with bilateral leg swelling and hypoalbuminemia was referred with an initial diagnosis of nephrotic syndrome. She had also abdominal pain and diarrhea. First a duodenal biopsy confirmed the diagnosis as CD. Nephrotic range proteinuria was detected so then a percutaneous renal biopsy was performed. Renal biopsy revealed membranoproliferative glomerulonephritis (MPGN) with C3 staining. Introduction of a gluten-free diet, ramipril, steroid and mycophenolic acid ameliorated clinical and laboratory parameters at three years follow up. Edema and hypoalbuminemia are common sharing clinical and laboratory parameters presented in not only patients with CD but also with glomerulonephritis. Urine analysis is very important in patients with CD to detect proteinuria. It is important to keep the possible link between CD and glomerulonephritis in mind for clinicians when working up a patient with diarrhea and nephrotic syndrome.
{"title":"A rare co-existence of celiac disease and C3 glomerulopathy","authors":"Ali Ilter , Meric Oruc , Sukran Sarikaya Kayipmaz , Ergun Parmaksiz","doi":"10.1016/j.nefro.2025.501336","DOIUrl":"10.1016/j.nefro.2025.501336","url":null,"abstract":"<div><div>Glomerulonephritis associated with celiac disease (CD) is rarely reported. Here we report a rare case of nephrotic syndrome associated with C3 glomerulopathy (C3G) in a patient with CD. A 19-year-old female with bilateral leg swelling and hypoalbuminemia was referred with an initial diagnosis of nephrotic syndrome. She had also abdominal pain and diarrhea. First a duodenal biopsy confirmed the diagnosis as CD. Nephrotic range proteinuria was detected so then a percutaneous renal biopsy was performed. Renal biopsy revealed membranoproliferative glomerulonephritis (MPGN) with C3 staining. Introduction of a gluten-free diet, ramipril, steroid and mycophenolic acid ameliorated clinical and laboratory parameters at three years follow up. Edema and hypoalbuminemia are common sharing clinical and laboratory parameters presented in not only patients with CD but also with glomerulonephritis. Urine analysis is very important in patients with CD to detect proteinuria. It is important to keep the possible link between CD and glomerulonephritis in mind for clinicians when working up a patient with diarrhea and nephrotic syndrome.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 7","pages":"Article 501336"},"PeriodicalIF":2.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721729","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}
Pub Date : 2025-06-04DOI: 10.1016/j.nefro.2025.501342
Diego Toso , Monica Furlano , Adria Tinoco , Tania Sensat Saltor , Elisabet Ars , Roser Torra
Cystinosis is a rare monogenic autosomal recessive disorder caused by pathogenic variants in the CTNS gene, encoding cystinosin. Loss-of-function of cystinosin leads to intralysosomal cystine accumulation, resulting in cellular dysfunction and multisystem involvement. In addition to symptomatic treatment, early initiation of cysteamine therapy and its strict adherence are essential to delay kidney failure and minimize extrarenal complications. We report the case of a 28-year-old woman diagnosed with infantile cystinosis at two years of age, treated with oral and topical cysteamine since then. Genetic testing identified two CTNS truncating variants associated with the infantile form: c.519_520del p.(Thr173*) and c.18_21del p.(Thr7Phefs*7). Despite a relatively late diagnosis and an unapproved dosing regimen, her leucocyte cystine levels have consistently remained below the upper limit, and both renal and extrarenal manifestations are well-controlled. This case highlights the phenotypic variability of cystinosis and underscores the importance of sustained cysteamine therapy in achieving favorable long-term outcomes, even when initiated later and maintained with an unconventional dosing regimen.
{"title":"Phenotypic variability in cystinosis: Lessons from an atypical case","authors":"Diego Toso , Monica Furlano , Adria Tinoco , Tania Sensat Saltor , Elisabet Ars , Roser Torra","doi":"10.1016/j.nefro.2025.501342","DOIUrl":"10.1016/j.nefro.2025.501342","url":null,"abstract":"<div><div>Cystinosis is a rare monogenic autosomal recessive disorder caused by pathogenic variants in the <em>CTNS</em> gene, encoding cystinosin. Loss-of-function of cystinosin leads to intralysosomal cystine accumulation, resulting in cellular dysfunction and multisystem involvement. In addition to symptomatic treatment, early initiation of cysteamine therapy and its strict adherence are essential to delay kidney failure and minimize extrarenal complications. We report the case of a 28-year-old woman diagnosed with infantile cystinosis at two years of age, treated with oral and topical cysteamine since then. Genetic testing identified two <em>CTNS</em> truncating variants associated with the infantile form: c.519_520del p.(Thr173*) and c.18_21del p.(Thr7Phefs*7). Despite a relatively late diagnosis and an unapproved dosing regimen, her leucocyte cystine levels have consistently remained below the upper limit, and both renal and extrarenal manifestations are well-controlled. This case highlights the phenotypic variability of cystinosis and underscores the importance of sustained cysteamine therapy in achieving favorable long-term outcomes, even when initiated later and maintained with an unconventional dosing regimen.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 7","pages":"Article 501342"},"PeriodicalIF":2.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721733","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}
Pub Date : 2025-06-03DOI: 10.1016/j.nefro.2025.501338
Alberto Ortiz , Ana Cebrián , Alfonso Soto , Andrés Reyes , Jose Luis Górriz
Background and objetive
Currently, patients with chronic kidney disease (CKD) and type-2 diabetes mellitus (T2DM) present a persistent residual renal and cardiovascular (CV) risk despite receiving standard treatment. Therefore, the aim was to assess the degree of multidisciplinary consensus on the persistent residual risk in these patients and its possible therapeutic approach.
Materials and methods
A Scientific Committee of 4 experts accustomed to the management of CKD and T2DM proposed the content of a Delphi questionnaire and the profile of panelists and validated the final questionnaire. A panel composed of 60 specialists in Nephrology (n = 20), Endocrinology (n = 20) and Primary Care (n = 20) completed the questionnaire specifically designed for the study, which contained 76 statements generated after a targeted literature review, to which 2 more statements were added for the second round. Using Delphi methodology adapted between May and June 2024, the panel assessed the statements included in the questionnaire in 2 rounds. Each statement was to be rated on an ordinal Likert-type scale from 1 to 9 points.
Results
A response was obtained from 60 specialists in the 2 rounds of the study. Seventy-two percent of the panelists had more than 15 years of experience, 70.0% followed more than 25 patients with CKD and T2DM monthly, and all belonged to a scientific society. In the first Delphi round, the defined level of agreement was reached for 43 statements and in the second round for 10 additional statements [53/78 (68%) consensus statements]. The section with consensus on the largest number of statements was residual risk (86.4%). In this block, the predefined level of agreement was reached in aspects such as elevated risk of renal complications (median; interquartile range: 9 [8-9]), CV (9 [8-9]) or premature death (9 [8-9]) despite receiving standard treatment, the complementary action of different drugs with different mechanism of action (9 [9-9]), the simultaneous establishment of 3 pillars of treatment [renin-angiotensin system blockade+SGLT2 inhibitors (iSGLT2)+Non-steroidal Mineralocorticoid Receptor Antagonists (mRNAs)] (8 [7-9]), the progress made by iSGLT2 (9 [9-9]) and ARMn (8 [7-9]) in renal and CV protection, and the need to avoid therapeutic inertia (9 [8-9]), use treatments early and intensively (9 [8-9]) and coordination between levels of care (9 [9-9]).
Conclusions
Multidisciplinary consensus was obtained that patients with T2DM and CKD present a high residual risk of disease progression, premature death, renal and CV complications. The simultaneous implementation of the 3 pillars of treatment, the avoidance of therapeutic inertia, and coordination between levels of care are considered relevant measures to contribute to reducing the residual risk in these patients.
{"title":"Estudio Delphi multidisciplinar sobre riesgo residual en pacientes con enfermedad renal crónica y diabetes mellitus tipo 2","authors":"Alberto Ortiz , Ana Cebrián , Alfonso Soto , Andrés Reyes , Jose Luis Górriz","doi":"10.1016/j.nefro.2025.501338","DOIUrl":"10.1016/j.nefro.2025.501338","url":null,"abstract":"<div><h3>Background and objetive</h3><div>Currently, patients with chronic kidney disease (CKD) and type-2 diabetes mellitus (T2DM) present a persistent residual renal and cardiovascular (CV) risk despite receiving standard treatment. Therefore, the aim was to assess the degree of multidisciplinary consensus on the persistent residual risk in these patients and its possible therapeutic approach.</div></div><div><h3>Materials and methods</h3><div>A Scientific Committee of 4 experts accustomed to the management of CKD and T2DM proposed the content of a Delphi questionnaire and the profile of panelists and validated the final questionnaire. A panel composed of 60 specialists in Nephrology (n<!--> <!-->=<!--> <!-->20), Endocrinology (n<!--> <!-->=<!--> <!-->20) and Primary Care (n<!--> <!-->=<!--> <!-->20) completed the questionnaire specifically designed for the study, which contained 76 statements generated after a targeted literature review, to which 2 more statements were added for the second round. Using Delphi methodology adapted between May and June 2024, the panel assessed the statements included in the questionnaire in 2 rounds. Each statement was to be rated on an ordinal Likert-type scale from 1 to 9 points.</div></div><div><h3>Results</h3><div>A response was obtained from 60 specialists in the 2 rounds of the study. Seventy-two percent of the panelists had more than 15 years of experience, 70.0% followed more than 25 patients with CKD and T2DM monthly, and all belonged to a scientific society. In the first Delphi round, the defined level of agreement was reached for 43 statements and in the second round for 10 additional statements [53/78 (68%) consensus statements]. The section with consensus on the largest number of statements was residual risk (86.4%). In this block, the predefined level of agreement was reached in aspects such as elevated risk of renal complications (median; interquartile range: 9 [8-9]), CV (9 [8-9]) or premature death (9 [8-9]) despite receiving standard treatment, the complementary action of different drugs with different mechanism of action (9 [9-9]), the simultaneous establishment of 3 pillars of treatment [renin-angiotensin system blockade+SGLT2 inhibitors (iSGLT2)+Non-steroidal Mineralocorticoid Receptor Antagonists (mRNAs)] (8 [7-9]), the progress made by iSGLT2 (9 [9-9]) and ARMn (8 [7-9]) in renal and CV protection, and the need to avoid therapeutic inertia (9 [8-9]), use treatments early and intensively (9 [8-9]) and coordination between levels of care (9 [9-9]).</div></div><div><h3>Conclusions</h3><div>Multidisciplinary consensus was obtained that patients with T2DM and CKD present a high residual risk of disease progression, premature death, renal and CV complications. The simultaneous implementation of the 3 pillars of treatment, the avoidance of therapeutic inertia, and coordination between levels of care are considered relevant measures to contribute to reducing the residual risk in these patients.</di","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 7","pages":"Article 501338"},"PeriodicalIF":2.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721730","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}
Pub Date : 2025-06-03DOI: 10.1016/j.nefro.2025.501335
Beatriz Martín-Carro , Sara Panizo , Raúl García-Castro , Sara Fernández-Villabrille , Nerea González-García , Minerva Rodríguez-García , Natalia Menéndez García , Jesús M. Fernández-Gómez , Miguel A. Hévia-Suárez , Elias Delgado , Emilio Sánchez-Álvarez , Juan F. Navarro-González , Manuel Naves-Díaz , Natalia Carrillo-López , José L. Fernández-Martín , Cristina Alonso-Montes
<div><h3>Background and objective</h3><div>The European COSMOS study, which included 6797 haemodialysis patients from 20 countries, demonstrated that elevated PTH levels were associated with a higher risk of mortality in diabetic patients compared to non-diabetic ones. Elevated PTH levels have been linked to inflammatory processes. This study aimed to analyse, in epigastric arteries of dialysis patients, whether diabetes and elevated PTH levels might synergistically modulate the expression of inflammatory and vascular calcification markers through ADAM17 and/or its inhibitor, TIMP3.</div></div><div><h3>Material and methods</h3><div>Epigastric artery samples were examined from 62 chronic kidney disease patients, 31 non-diabetic and 31 diabetic with similar characteristics, obtained during kidney transplantation. The gene expression of ADAM17, TIMP3, inflammatory markers (TNF-α, VCAM, and ICAM), α-actin, DKK1, and RUNX2, as well as protein expression of RUNX2 and vascular calcification, were evaluated. Analyses were performed based on the presence/absence of diabetes and serum PTH levels (using the median value as the cut-off). Differences between groups were assessed using Chi-squared tests for qualitative variables or Wilcoxon tests for quantitative variables.</div></div><div><h3>Results</h3><div>In the epigastric arteries of diabetic patients, there was lower gene expression of TIMP3 (1.0 [0.8] vs. 0.6 [0.5] R. U.; p<!--> <!-->=<!--> <!-->0.028) and α-actin (1.0 [0.6] vs. 0.7 [0.5] R. U.; p<!--> <!-->=<!--> <!-->0.006), higher gene expression of VCAM (1.0 [0.9] vs. 2.1 [2.8] R. U.; p<!--> <!-->=<!--> <!-->0.011), TNF-α (1.0 [1.1] vs. 2.0 [1.9] R. U.; p<!--> <!-->=<!--> <!-->0.008), and RUNX2 (1.0 [0.8] vs. 2.4 [2.8] R. U.; p<!--> <!-->=<!--> <!-->0.009), and a higher percentage of RUNX2-positive nuclei (14.9 [15.8] vs. 31.1 [27.1]; p<!--> <!-->=<!--> <!-->0.038) compared to non-diabetic patients. Arteries from patients with PTH levels above the median exhibited higher gene expression of ADAM17 (1.0 [0.6] vs. 1.8 [1.6] R. U.; p<!--> <!-->=<!--> <!-->0.026). The increase in ADAM17 expression persisted when only diabetic patients were analysed (1.0 [0.5] vs. 2.9 [2.9] R. U.; p<!--> <!-->=<!--> <!-->0.038), but not in non-diabetic patients. The combination of elevated PTH and diabetes was associated with higher gene expression of RUNX2 (1.0 [0.8] vs. 2.7 [3.3] R. U.; p<!--> <!-->=<!--> <!-->0.019), a higher percentage of RUNX2-positive nuclei (13.3 [17.0] vs. 32.9 [27.2]; p<!--> <!-->=<!--> <!-->0.039), and a higher Kauppila index (3.9 [5.0] vs. 9.7 [7.3]; p<!--> <!-->=<!--> <!-->0.045).</div></div><div><h3>Conclusions</h3><div>Although changes in ADAM17 and TIMP3 gene expression were observed in diabetic patients, potentially related to increased synthesis and/or release of pro-inflammatory factors, these do not appear to explain the difference in mortality associated with elevated PTH levels between diabetic and non-diabetic patients observed in t
{"title":"Expresión de ADAM17 y niveles de PTH sérica en pacientes con y sin diabetes en diálisis: posibles implicaciones en la calcificación vascular","authors":"Beatriz Martín-Carro , Sara Panizo , Raúl García-Castro , Sara Fernández-Villabrille , Nerea González-García , Minerva Rodríguez-García , Natalia Menéndez García , Jesús M. Fernández-Gómez , Miguel A. Hévia-Suárez , Elias Delgado , Emilio Sánchez-Álvarez , Juan F. Navarro-González , Manuel Naves-Díaz , Natalia Carrillo-López , José L. Fernández-Martín , Cristina Alonso-Montes","doi":"10.1016/j.nefro.2025.501335","DOIUrl":"10.1016/j.nefro.2025.501335","url":null,"abstract":"<div><h3>Background and objective</h3><div>The European COSMOS study, which included 6797 haemodialysis patients from 20 countries, demonstrated that elevated PTH levels were associated with a higher risk of mortality in diabetic patients compared to non-diabetic ones. Elevated PTH levels have been linked to inflammatory processes. This study aimed to analyse, in epigastric arteries of dialysis patients, whether diabetes and elevated PTH levels might synergistically modulate the expression of inflammatory and vascular calcification markers through ADAM17 and/or its inhibitor, TIMP3.</div></div><div><h3>Material and methods</h3><div>Epigastric artery samples were examined from 62 chronic kidney disease patients, 31 non-diabetic and 31 diabetic with similar characteristics, obtained during kidney transplantation. The gene expression of ADAM17, TIMP3, inflammatory markers (TNF-α, VCAM, and ICAM), α-actin, DKK1, and RUNX2, as well as protein expression of RUNX2 and vascular calcification, were evaluated. Analyses were performed based on the presence/absence of diabetes and serum PTH levels (using the median value as the cut-off). Differences between groups were assessed using Chi-squared tests for qualitative variables or Wilcoxon tests for quantitative variables.</div></div><div><h3>Results</h3><div>In the epigastric arteries of diabetic patients, there was lower gene expression of TIMP3 (1.0 [0.8] vs. 0.6 [0.5] R. U.; p<!--> <!-->=<!--> <!-->0.028) and α-actin (1.0 [0.6] vs. 0.7 [0.5] R. U.; p<!--> <!-->=<!--> <!-->0.006), higher gene expression of VCAM (1.0 [0.9] vs. 2.1 [2.8] R. U.; p<!--> <!-->=<!--> <!-->0.011), TNF-α (1.0 [1.1] vs. 2.0 [1.9] R. U.; p<!--> <!-->=<!--> <!-->0.008), and RUNX2 (1.0 [0.8] vs. 2.4 [2.8] R. U.; p<!--> <!-->=<!--> <!-->0.009), and a higher percentage of RUNX2-positive nuclei (14.9 [15.8] vs. 31.1 [27.1]; p<!--> <!-->=<!--> <!-->0.038) compared to non-diabetic patients. Arteries from patients with PTH levels above the median exhibited higher gene expression of ADAM17 (1.0 [0.6] vs. 1.8 [1.6] R. U.; p<!--> <!-->=<!--> <!-->0.026). The increase in ADAM17 expression persisted when only diabetic patients were analysed (1.0 [0.5] vs. 2.9 [2.9] R. U.; p<!--> <!-->=<!--> <!-->0.038), but not in non-diabetic patients. The combination of elevated PTH and diabetes was associated with higher gene expression of RUNX2 (1.0 [0.8] vs. 2.7 [3.3] R. U.; p<!--> <!-->=<!--> <!-->0.019), a higher percentage of RUNX2-positive nuclei (13.3 [17.0] vs. 32.9 [27.2]; p<!--> <!-->=<!--> <!-->0.039), and a higher Kauppila index (3.9 [5.0] vs. 9.7 [7.3]; p<!--> <!-->=<!--> <!-->0.045).</div></div><div><h3>Conclusions</h3><div>Although changes in ADAM17 and TIMP3 gene expression were observed in diabetic patients, potentially related to increased synthesis and/or release of pro-inflammatory factors, these do not appear to explain the difference in mortality associated with elevated PTH levels between diabetic and non-diabetic patients observed in t","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 7","pages":"Article 501335"},"PeriodicalIF":2.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721731","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}
Pub Date : 2025-06-01DOI: 10.1016/j.nefro.2025.01.010
Vitória Paes de Faria , Joana Dias , Rute Carmo , Daniela Lopes , João Carlos Fernandes , Maria Clara Almeida , Ana Marta Gomes
Diabetes is a major cause of chronic kidney disease worldwide. Managing CKD in diabetic patients is complex due to accumulation of comorbid conditions such as hypertension, cerebrovascular and peripheral artery disease, as well as increased risk of infection and malnutrition. Reaching end-stage kidney disease, many diabetic patients will choose peritoneal dialysis. This review explores the epidemiology, outcomes, and specific management challenges of diabetic patients undergoing peritoneal dialysis. Literature from PubMed and MEDLINE from 2000 to 2023 was methodically reviewed. In a patient population with increased cardiovascular risk and unique metabolic challenges, the need for individualized treatment strategies in order to improve clinical outcomes is underscored.
{"title":"Particularities of peritoneal dialysis in diabetic patients","authors":"Vitória Paes de Faria , Joana Dias , Rute Carmo , Daniela Lopes , João Carlos Fernandes , Maria Clara Almeida , Ana Marta Gomes","doi":"10.1016/j.nefro.2025.01.010","DOIUrl":"10.1016/j.nefro.2025.01.010","url":null,"abstract":"<div><div>Diabetes is a major cause of chronic kidney disease worldwide. Managing CKD in diabetic patients is complex due to accumulation of comorbid conditions such as hypertension, cerebrovascular and peripheral artery disease, as well as increased risk of infection and malnutrition. Reaching end-stage kidney disease, many diabetic patients will choose peritoneal dialysis. This review explores the epidemiology, outcomes, and specific management challenges of diabetic patients undergoing peritoneal dialysis. Literature from PubMed and MEDLINE from 2000 to 2023 was methodically reviewed. In a patient population with increased cardiovascular risk and unique metabolic challenges, the need for individualized treatment strategies in order to improve clinical outcomes is underscored.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 6","pages":"Article 101324"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611906","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}
Pub Date : 2025-06-01DOI: 10.1016/j.nefro.2025.01.005
Javier Martín Benlloch, Ana Adell Sales, Ana Ledo García, Pilar Pérez Pintado, Maria Luisa Matoses Ruipérez, Joan Pacheco Campello, Pedro José Ortega López
{"title":"Respuesta cardiovascular asociada a una catástrofe natural en un paciente pediátrico. Evidencia directa mediante monitorización ambulatoria de la presión arterial","authors":"Javier Martín Benlloch, Ana Adell Sales, Ana Ledo García, Pilar Pérez Pintado, Maria Luisa Matoses Ruipérez, Joan Pacheco Campello, Pedro José Ortega López","doi":"10.1016/j.nefro.2025.01.005","DOIUrl":"10.1016/j.nefro.2025.01.005","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 6","pages":"Article 101319"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611913","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}
Pub Date : 2025-06-01DOI: 10.1016/j.nefro.2025.02.005
Jessy Korina Peña-Esparragoza , José Ángel Lorente , José Luis Izquierdo , Judith Martins
{"title":"Nuevas perspectivas de biomarcadores de insuficiencia renal aguda: papel de la metabolómica","authors":"Jessy Korina Peña-Esparragoza , José Ángel Lorente , José Luis Izquierdo , Judith Martins","doi":"10.1016/j.nefro.2025.02.005","DOIUrl":"10.1016/j.nefro.2025.02.005","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 6","pages":"Article 101329"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611914","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}
Pub Date : 2025-06-01DOI: 10.1016/j.nefro.2025.01.001
Alberto Esteban-Fernández , Carlos de Blas-Ruiz , Maitane Fernández-Ustoa , Elena Gabaldón-Perucha , Beatriz López-Gómez , Guadalupe Ruiz-Martín
{"title":"Eligibility for finerenone in real-world patients with diabetes and chronic kidney disease: Insights from the FIDELITY pooled analysis","authors":"Alberto Esteban-Fernández , Carlos de Blas-Ruiz , Maitane Fernández-Ustoa , Elena Gabaldón-Perucha , Beatriz López-Gómez , Guadalupe Ruiz-Martín","doi":"10.1016/j.nefro.2025.01.001","DOIUrl":"10.1016/j.nefro.2025.01.001","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 6","pages":"Article 101315"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611911","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}
Pub Date : 2025-06-01DOI: 10.1016/j.nefro.2025.501353
Rita Leal , Pedro Almiro e Castro , Rui Duarte , Ana Rita Silva , Maria Guedes Marques , Luís Rodrigues , Lídia Santos , Catarina Romãozinho , Helena Oliveira Sá , Arnaldo Figueiredo , Rui Alves
Introduction and objectives
Kidney transplant (KT) recipients who experience graft failure and return to dialysis face a higher risk of adverse outcomes. This study aimed to identify risk factors for hospitalization and mortality two years post-graft failure.
Materials and methods
We conducted a retrospective cohort study of end-stage kidney disease patients who initiated hemodialysis following graft failure between January 2019 and December 2020. The Clinical Frailty Scale (CFS) and the Charlson Comorbidity Index (CCI) were assessed for each patient at the time of graft loss. The primary outcomes were hospitalization and all-cause mortality over a two-year follow-up period.
Results
A total of 107 patients were included, with a mean age of 55.9 years and a mean graft survival of 134 months. The two-year hospitalization rate was 37.4%, with lower residual diuresis and higher CFS identified as independent risk factors. The two-year mortality rate was 16.8%. A multivariate regression model, explaining 82% of the variance, confirmed that higher CCI, higher CFS, and lower residual diuresis significantly increased mortality risk. A CCI cut-off of ≥8 (AUC 0.95) further stratified patients at elevated mortality risk. Immunological and transplant-related variables did not influence mortality or hospitalization risk.
Conclusions
In this cohort, frailty defined by CFS was associated with hospitalization and mortality, while comorbidity burden evaluated by CCI was strongly related to mortality. These tools may help personalize the care of patients with a failing graft.
{"title":"Clinical Frailty Scale and Charlson Comorbidity Index as predictors of hospitalization and mortality risk after kidney transplant failure","authors":"Rita Leal , Pedro Almiro e Castro , Rui Duarte , Ana Rita Silva , Maria Guedes Marques , Luís Rodrigues , Lídia Santos , Catarina Romãozinho , Helena Oliveira Sá , Arnaldo Figueiredo , Rui Alves","doi":"10.1016/j.nefro.2025.501353","DOIUrl":"10.1016/j.nefro.2025.501353","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Kidney transplant (KT) recipients who experience graft failure and return to dialysis face a higher risk of adverse outcomes. This study aimed to identify risk factors for hospitalization and mortality two years post-graft failure.</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective cohort study of end-stage kidney disease patients who initiated hemodialysis following graft failure between January 2019 and December 2020. The Clinical Frailty Scale (CFS) and the Charlson Comorbidity Index (CCI) were assessed for each patient at the time of graft loss. The primary outcomes were hospitalization and all-cause mortality over a two-year follow-up period.</div></div><div><h3>Results</h3><div>A total of 107 patients were included, with a mean age of 55.9 years and a mean graft survival of 134 months. The two-year hospitalization rate was 37.4%, with lower residual diuresis and higher CFS identified as independent risk factors. The two-year mortality rate was 16.8%. A multivariate regression model, explaining 82% of the variance, confirmed that higher CCI, higher CFS, and lower residual diuresis significantly increased mortality risk. A CCI cut-off of ≥8 (AUC 0.95) further stratified patients at elevated mortality risk. Immunological and transplant-related variables did not influence mortality or hospitalization risk.</div></div><div><h3>Conclusions</h3><div>In this cohort, frailty defined by CFS was associated with hospitalization and mortality, while comorbidity burden evaluated by CCI was strongly related to mortality. These tools may help personalize the care of patients with a failing graft.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 6","pages":"Article 501353"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611908","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}
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