BMC Nephrology最新文献

Background: Comparison of a patient's abnormal serum creatinine result to an earlier value is fundamental to differentiating Acute Kidney Injury (AKI) from Chronic Kidney Disease (CKD), and is the first step in electronic AKI detection systems. For those patients in whom a baseline serum creatinine is unavailable, some systems generate a warning message to highlight the elevated serum creatinine but without distinguishing AKI from CKD (a "?AKI?CKD" warning). We aimed to determine demographic characteristics of this group, the proportion who had a first presentation of AKI, their clinical outcomes, and how these alert messages translate into subsequent biochemical testing and follow-up.

Methods: We performed a retrospective cohort analysis of adult patients with serum creatinine testing at University Hospitals of Leicester during 2019. Using the NHS England AKI detection algorithm, we identified patients with AKI Warning Test Scores (WTS) and "?AKI?CKD" warnings. The "?AKI?CKD" cohort was classified as probable AKI, probable CKD, or no follow-up result, based on subsequent serum creatinine measurements. Survival (90-day and 1-year) was analysed with Kaplan-Meier methods.

Results: Among 3,464 patients with "?AKI?CKD" warnings, 8.5% were probable AKI, 59.4% probable CKD, and 32.0% had no follow-up test. Probable AKI patients were younger (median age 71 versus 76 years) and more often hospitalised at warning time (56% versus 15%). One-year survival was lower in probable AKI (72%) compared to probable CKD (88%) or no follow-up (89%). Probable AKI survival was similar to AKI WTS stage 1 but better than stages 2-3. Extending baseline serum creatinine look-back to 426 days changed categorisation minimally (≤ 2%).

Conclusions: These findings highlight that the major feature of the "?AKI?CKD" classification is not simply misclassification between AKI and CKD, but the variability of clinical response, with one-third of patients receiving no subsequent serum creatinine test. Most patients flagged as "?AKI?CKD" likely have CKD rather than AKI, and this, coupled with comparable outcomes of the probable AKI group to early-stage AKI, suggests minimal missed population-level AKI detection. However, one-third lacked follow-up testing, highlighting missed opportunities to identify CKD.

Clinical trial number: Not applicable.

Background: End-stage renal disease (ESRD) patients receiving hemodialysis are experiencing a considerable increase in the burden of cardiovascular diseases (CVDs). In this patient population, hypertension is a prevalent modifiable cardiovascular risk factor that is associated with poor prognosis. Resistant hypertension in dialysis patients is challenging to manage since some individuals do not respond to antihypertensive medications or volume control. Hyperhomocysteinemia is common among ESRD patients. "H-type hypertension" or hyperhomocysteinemia-associated hypertension refers to resistant hypertension with elevated cardiovascular risk. The current study examined the efficacy of methylfolate and methylcobalamin supplementation in reducing serum homocysteine levels and improving blood pressure (BP) control in ESRD patients with resistant hypertension on regular hemodialysis.

Methods: Throughout the study, 51 ESRD patients with resistant hypertension were randomly allocated to receive either daily doses of L-methylfolate 800 mcg and methylcobalamin 1000 mcg capsule (intervention group) or no medication (control group). Serum homocysteine levels were measured twice: at baseline and three months later. In addition, average pre- and post-dialysis blood pressure readings were obtained at baseline, one month, two months, and three months.

Results: After three months, mean serum homocysteine levels were significantly lower than at the commencement of therapy (p = 0.035), nonetheless, control patients showed no significant difference. Between-group analysis found a statistically significant difference in the change in homocysteine levels among the two groups (p = 0.006). Furthermore, the treatment group had statistically significant lower pre- and post-dialysis blood pressure readings.

Conclusions: A three-month supplementation with a combination of 800 mcg methylfolate and 1000 mcg methylcobalamin showed promise in lowering blood pressure and serum homocysteine levels in ESRD patients with resistant hypertension. These findings require additional exploration in larger studies.

Trial registration: ClinicalTrials.gov Identifier NCT05807711 registered on 20,230,329.

Background: There is no gold standard for assessment of medication adherence. This study aimed to systematically review the literature to identify validated medication adherence measurement tools and methods used in clinical practice and research settings in the context of patients with chronic kidney disease (CKD) and to synthesize key features of the identified medication adherence tools.

Methods: We systematically reviewed MEDLINE via Ovid, Embase via Ovid, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL (via EBSCO) from inception to September 25, 2025. All abstracts were screened by pairs of reviewers independently, followed by a full-text review identifying the tool/method used for measuring medication adherence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this systematic review. General study and medication adherence method/tool-specific characteristics were summarized. The quality criteria for measurement properties were applied across the included studies to synthesize and assess the strength of the evidence.

Results: The 43 included articles originated from 25 countries. The most common measures used for evaluating medication adherence were the Eight-Item Morisky Medication Adherence Scale (MMAS-8) (n = 11 [25.6%]), Medication Possession Ratio (MPR) (n = 10 [23.3%]), Proportion of Days Covered (PDC) (n = 8 [18.6%]), and Medication Events Monitoring System (MEMS) (n = 6 [14.0%]). Five (15.6%) studies used multiple methods to measure medication adherence.

Conclusion: No accepted reference tool is available to measure CKD patients' medication adherence. Some tools, however, were used more frequently in the context of patients with CKD. Choosing an appropriate method/tool or a combination of methods depends on the clinician/researcher's goals, study setting, availability of data and other resources, and patients' characteristics.