Clinical Kidney Journal[JOURNAL]
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200 papers
National survey among French adult nephrologists on red blood cell transfusion in the early post-kidney transplantation period: time for evidence-based guidance.
Sajous T, Lievre L, Colosio C … +6 more , Schvartz B, Mokri L, Braconnier A, Wynckel A, Rieu P, Dupont V
Clin Kidney J · 2026 Feb · PMID 41704428 · Full text
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Transforming nephrology through artificial intelligence: a state-of-the-art roadmap for clinical integration.
Cheungpasitporn W, Athavale A, Ghazi L … +7 more , Kashani KB, Colicchio T, Koyner JL, Chen J, Ix JH, Nadkarni G, Neyra JA
Clin Kidney J · 2026 Feb · PMID 41704427 · Full text
Artificial intelligence (AI), encompassing machine learning, deep learning and generative AI, is poised to redefine nephrology by enabling earlier detection, more precise risk stratification and workflow-integrated clini...
Artificial intelligence (AI), encompassing machine learning, deep learning and generative AI, is poised to redefine nephrology by enabling earlier detection, more precise risk stratification and workflow-integrated clinical decision support across the spectrum of kidney disease. This state-of-the-art review synthesizes emerging applications of AI in acute kidney injury (AKI), chronic kidney disease (CKD), dialysis and kidney transplantation, with attention to clinical integration, real-world validation, workflow implementation and translational challenges. In AKI, predictive models trained on high-frequency electronic health record data and intensive care unit telemetry have demonstrated strong performance in forecasting critical events, yet translation into routine clinical workflows remains limited. In CKD, machine learning tools support progression risk stratification and phenotype clustering, with the potential to inform individualized surveillance and therapy. AI-enabled dialysis management systems optimize ultrafiltration, anemia control and vascular access surveillance, while generative AI and large language models offer novel capabilities for clinical documentation, triage and patient education. In transplantation, AI applications span organ allocation, dynamic graft monitoring and digital pathology-assisted rejection classification, with validated tools such as the iBox system gaining regulatory recognition. Implementation challenges include data heterogeneity, bias, interpretability, regulatory uncertainty and workflow integration. Looking ahead, multimodal integration of imaging, pathology and multi-omics data may support biologically informed precision nephrology. Reinforcement learning, digital twins and ambient intelligence are emerging as adaptive decision-support paradigms rather than autonomous care systems. Regulatory frameworks are evolving to accommodate adaptive algorithms, underscoring the need for clinician engagement in model development, validation and deployment. As AI matures from pilot to practice, nephrologists who embrace and help shape these tools will lead the transition toward a more personalized, efficient and equitable future for kidney care.
Prioritising genetic testing for kidney stone disease in adults using a clinical scoring system.
Maffei Faccioli F, Cozzolino MG, Moochhala SH
Clin Kidney J · 2026 Feb · PMID 41704426 · Full text
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Microscopic hematuria in IgA nephropathy: a biomarker of disease activity.
Floege J, Fervenza FC, Coppo R
Clin Kidney J · 2026 Feb · PMID 41704425 · Full text
Immunoglobulin A nephropathy (IgAN) is an immune-mediated disease of B-cell origin and the most common primary glomerulonephritis worldwide, which often progresses to kidney failure within 10-20 years of diagnosis. Micro...
Immunoglobulin A nephropathy (IgAN) is an immune-mediated disease of B-cell origin and the most common primary glomerulonephritis worldwide, which often progresses to kidney failure within 10-20 years of diagnosis. Microscopic hematuria is frequently observed in IgAN; it is thought to result from damage to the glomerular filtration barrier caused by pathogenic immune complex deposits, allowing red blood cells to leak into the urinary space. Emerging evidence suggests that microscopic hematuria in IgAN may be linked to active glomerular inflammation, poorer disease prognosis and progressive kidney function decline. Despite this, it remains an underutilized biomarker for IgAN because of a lack of standardization (which can lead to preanalytical errors), challenging logistical considerations in large multicenter trials and non-glomerular hematuria as a confounding factor. The "proteinuria-centric" approach by the nephrology community may overlook that active forms of glomerulonephritis manifest with both proteinuria and hematuria, in contrast to primary podocytopathies where proteinuria is the main feature. When properly assessed, microscopic hematuria is a prognostically relevant biomarker in IgAN that may improve risk stratification and assessment of therapeutic response when evaluated alongside traditional biomarkers. This review evaluates the methods of assessment, pathophysiology and clinical utility of microscopic hematuria in IgAN.
Epidemiology and risk factors of urolithiasis: insights from SKIPOGH, a population-based cohort study in Switzerland.
Stritt K, Plouvin M, Younes SE … +7 more , Ponte B, Ackermann D, Fuster DG, Bonny O, Roth B, Bochud M, Pruijm M
Clin Kidney J · 2026 Feb · PMID 41695656 · Full text
BACKGROUND: Kidney stones represent a growing global health concern, with a lifetime prevalence estimated at 7%-13% in North America and 1%-5% in Asia, but European data are scarce. We assessed the prevalences and incide...
BACKGROUND: Kidney stones represent a growing global health concern, with a lifetime prevalence estimated at 7%-13% in North America and 1%-5% in Asia, but European data are scarce. We assessed the prevalences and incidence of kidney stones in the Swiss adult population and identified associated factors. METHODS: The Swiss Kidney Project on Genes in Hypertension (SKIPOGH) is a multicenter cohort including 1128 participants recruited from the general population of Lausanne, Geneva and Bern (2009-12). All underwent renal ultrasound at baseline and completed a standardized questionnaire. Predefined demographic, lifestyle and clinical variables included age, sex, BMI, education, smoking, physical activity, hypertension, diabetes, history of kidney stones, laboratory and urinary parameters. A follow-up visit was performed 3 years later. Logistic regression analysis was performed to identify factors associated with kidney stone prevalence at baseline and 3-year incidence of newly formed stones. RESULTS: Ultrasound-detected kidney stones were present in 5.6% (6.1% men and 5.1% women). The 3-year incidence of new stones was 4.3% (4.1% men, 4.6% women). In multivariable logistic regression analysis, diabetes mellitus [odds ratio (OR) 2.93, 95% confidence interval (CI) 1.05-8.21, = .04], a family history of kidney stones (OR 9.96, 95% CI 4.53-21.91, < .01) and higher serum creatinine (OR 1.02 per µmol/L, 95% CI 1.00-1.04, = .02) were associated with the prevalence of kidney stones. Active smoking (OR 2.49, 95% CI 1.07-5.78, = .03), lower physical activity score (OR 0.82, 95% CI 0.67-1.00, = .05) and a personal history of kidney stones (OR 33.0, 95% CI 12.4-87.6, < .01) were associated with the 3-year incidence of kidney stones. CONCLUSION: In this Swiss cohort, the prevalence of kidney stones was lower than that reported in North America but higher than in Asian populations. Diabetes mellitus, family history of kidney stones were the strongest risk factors for prevalent stones, while a personal history of kidney stones and low physical activity were predictors of incident stone formation. These data will help to inform prevention strategies.
10 tips on performing economic evaluation in kidney disease.
Fotheringham J, Hill H, Mandrik O … +1 more , Erickson K
Clin Kidney J · 2026 Feb · PMID 41695655 · Full text
Nephrology has benefited from a growing body of high-quality clinical evidence, including clinical trials of pharmacological therapies and health service research on alternative care approaches. Consequently, there is an...
Nephrology has benefited from a growing body of high-quality clinical evidence, including clinical trials of pharmacological therapies and health service research on alternative care approaches. Consequently, there is an increasing need to perform economic evaluations in kidney disease to inform reimbursement decisions and optimise healthcare spending, thereby improving patient care within budget constraints. Cost-effectiveness assesses if the additional health gains are worth any additional costs by estimating differences in the quality and quantity of life, and the costs, from the point of intervention over observed but also longer (even lifetime) timelines, capturing the entire patient pathway through healthcare, e.g. from early-stage chronic kidney disease (CKD) through to dialysis or transplantation. Working with stakeholders to define the decision problem, merging evidence from a range of sources, including clinical trials complicated by limited follow-up and non-generalisable participants, surrogacy studies to estimate the intervention's impact on longer-term kidney failure risk, quality of life data collected ideally using instruments sensitive to kidney disease progression and other real-world data are required to make extrapolations sufficiently far into the patient's lifetime to capture kidney failure. Consideration of disadvantaged populations and how interventions may operate differently in certain groups may be indicated. Failure to capture competing risks of cardiovascular disease and death will bias estimates of kidney failure. Application of our tips, combined with an understanding of how decision-makers use cost-effectiveness results and information about factors like rarity and disease severity maximises the likelihood of new kidney treatments and care approaches being adopted.
Peritoneal dialysis effluent biomarkers from a multi-omics and artificial intelligence perspective: advances and challenges.
Li H, Yu F, Wang X … +5 more , Yao Y, Xu H, Cai Y, Xin S, Chen K
Clin Kidney J · 2026 Feb · PMID 41685257 · Full text
Long-term peritoneal dialysis (PD) treatment can lead to the destruction of peritoneal structure and function, which can lead to PD failure or even a poor prognosis. However, validated early biomarkers for patients under...
Long-term peritoneal dialysis (PD) treatment can lead to the destruction of peritoneal structure and function, which can lead to PD failure or even a poor prognosis. However, validated early biomarkers for patients undergoing PD are lacking. PD effluent (PDE) is rich in various biological components, such as nucleic acids, proteins, and metabolites, and is now an important source of noninvasive biomarkers for the dynamic monitoring of disease progression. In recent studies, a variety of histological techniques have provided unprecedented depth and breadth to PD biomarker research, and are becoming key tools in the early diagnosis, prognosis, and therapeutic monitoring of PD patients. Correspondingly, artificial intelligence (AI) approaches, which can flexibly handle data and excel at mining nonlinear and high-dimensional relationships in multimodal data, have moved from theory to practice. AI-based multi-omics analysis has not only greatly improved the understanding of the pathophysiological mechanisms of PD-associated fibrosis (PF) but has also contributed to the development of new biomarkers and novel targets. This review provides a comprehensive summary of recent advances in the development of PDE biomarkers using AI-based multi-omics approaches. We highlight the application of AI-based multi-omics techniques for early diagnosis, evaluation of peritoneal injury, assessment of peritoneal function, and prediction of prognosis. Finally, we discuss the challenges and limitations of PDE biomarkers from the perspectives of multi-omics and AI. In conclusion, AI-based multi-omics analysis holds great promise for the development of PDE biomarkers, which are expected to significantly improve the prognosis of PD patients and ultimately facilitate precision medicine.
Genetic screening in kidney transplant candidates.
Le Moal P, Knebelmann B, Hummel A … +8 more , Gribouval O, Anglicheau D, Legendre C, Morinière V, Heidet L, Dorval G, Antignac C, Servais A
Clin Kidney J · 2026 Feb · PMID 41669536 · Full text
BACKGROUND: The origin of chronic kidney disease (CKD) remains unknown in ≈16% of patients at the time of renal replacement therapy. The aim of this study was to assess the proportion of monogenic kidney diseases in kidn...
BACKGROUND: The origin of chronic kidney disease (CKD) remains unknown in ≈16% of patients at the time of renal replacement therapy. The aim of this study was to assess the proportion of monogenic kidney diseases in kidney transplant candidates with kidney disease of unknown cause. METHODS: Transplant candidates, referred to a nephrogenetic outpatient clinic, had a molecular investigation and were included if they met the following inclusion criteria: absence of diagnosis (including presumed hypertensive nephropathy or vascular or focal segmental glomerulosclerosis lesions) and a glomerular filtration rate <30 ml/min/1.73 m before 50 years of age and/or renal morphology abnormality (including renal hypotrophy, cysts and congenital anomalies of the kidney and urinary tract) and/or extrarenal involvement and/or family history of CKD. RESULTS: Eighty-nine patients were evaluated at the nephrogenetic consultation and 84 patients met the inclusion criteria and were tested and included. Half had a family history of CKD. Almost half of the patients (46.4%) had a morphological abnormality of the kidney. Twenty-eight (33.3%) had been biopsied: 21% had focal and segmental hyalinosis lesions and 25% had chronic interstitial nephropathy. Thirty patients (36%) had a positive genetic diagnosis. Of these, 9/30 (30%) had high-risk alleles and 21/30 (70%) had monogenic nephropathy. Patients with a positive genetic diagnosis were significantly more likely to have a family history of kidney disease (70% versus 37%; = .004). CONCLUSIONS: Genetic testing enables a diagnosis to be established in 36% of patients, allowing genetic counselling and may help potential living donor evaluations.
Use of acetazolamide in volume overload: start at the beginning.
Arora N, Ellison DH
Clin Kidney J · 2026 Feb · PMID 41669535 · Full text
The treatment of volume overload has vexed physicians for centuries. References to herbal remedies for the treatment of fluid retention date as far back as 1550 BC in the Ebers Papyrus from Ancient Egypt [1]. The term ed...
The treatment of volume overload has vexed physicians for centuries. References to herbal remedies for the treatment of fluid retention date as far back as 1550 BC in the Ebers Papyrus from Ancient Egypt [1]. The term edema originates from the Greek "to swell," and the Greek hero Oedipus, meaning "swollen foot," was so named due to the swelling of his feet from injuries inflicted by his mother to prevent the fulfillment of a prophecy. There are several references to edema in the writings of Hippocrates, with various proposed treatments, ranging from herbal remedies, purgatives, phlebotomy, and cranial decompression. The word dropsy, from the Greek word for water, originated in the Middle English period and came to describe conditions associated with an accumulation of fluid in body tissue, preceding more sophisticated knowledge of distinctive disease states. Physicians often prescribed treatments such as bloodletting, purgatives, leeches, and Southey tubes, which were invented in 1877 by English physician Reginald Southey. These were small cannulas placed in a patient's swollen extremities to relieve edema, used until the 1960s [2]. It was not until the serendipitous discovery of the diuretic properties of the mercurial agent Novasurol by Alfred Vogl, while working as a medical student at the Wenckebach clinic in Vienna, used to treat a young patient with congenital syphilis [3], that spurred the interest in synthetic diuretic agents. Despite being the first agent synthesized, acetazolamide became the "forgotten diuretic" until a recent resurgence has reinvigorated interest in its utility in patients with acute decompensated heart failure. This review will describe the background, clinical trials, and proposed utility of acetazolamide in states of volume overload.
Real-world eligibility for FSGS clinical trials: insights from a US health system.
Munis MA, Chen Q, Smith A … +3 more , Garcia CL, Fuller D, Sim JJ
Clin Kidney J · 2026 Feb · PMID 41658281 · Full text
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Systemic inflammation and B cell indices predict rituximab responses in membranous nephropathy.
Duan S, Ye Y, Zhou Q … +7 more , Hua H, Zeng M, Zhang C, Yuan Y, Xing C, Mao H, Zhang B
Clin Kidney J · 2026 Feb · PMID 41658280 · Full text
BACKGROUND: Membranous nephropathy (MN) is a frequent cause of nephrotic syndrome in adults with variable response to rituximab (RTX) therapy. While traditional markers like proteinuria and anti-phospholipase A2 receptor...
BACKGROUND: Membranous nephropathy (MN) is a frequent cause of nephrotic syndrome in adults with variable response to rituximab (RTX) therapy. While traditional markers like proteinuria and anti-phospholipase A2 receptor (PLA2R) antibodies exhibit predictive value, their limitations necessitate more robust biomarkers. METHODS: We prospectively analysed 149 MN patients receiving RTX over 12 months. Inflammatory indices such as neutrophil:lymphocyte ratio (NLR), monocyte:lymphocyte ratio (MLR) and systemic inflammation response index (SIRI) together with B cell levels were measured alongside conventional markers at baseline, 3 months and 6 months. Predictive models for 6- and 12-month remission (complete/partial) were developed using multivariate regression and receiver operating characteristics (ROC) analysis. RESULTS: Non-responders exhibited persistently elevated inflammatory markers (NLR, MLR, SIRI) throughout the entire observation period. Among the three, only SIRI can independently predict the remission of MN. At 3 months, SIRI ≤1.25 {odds ratio [OR] 3.68 [95% confidence interval (CI) 1.39-9.72]} and B cell proportion ≤0.2% [OR 2.90 (95% CI 1.00-8.35)] independently predicted 6-month response. Incorporating these two newly added indicators into the traditional variable model, which includes the levels of proteinuria, albumin and anti-PLA2R antibody at 3 months, markedly enhances prediction accuracy [area under the curve (AUC) 0.86 versus 0.81]. By 6 months, only SIRI ≤0.9 [OR 4.84 (95% CI 1.43-16.40)] and albumin change [OR 1.11 (95% CI 1.03-1.19)] predicted 12-month prognosis, as B cell and anti-PLA2R antibody levels lost significance. The prediction model incorporating SIRI also had better performance (AUC 0.82 versus 0.79). CONCLUSIONS: B lymphocyte levels constitute a robust predictive biomarker for assessing short-term therapeutic response in patients with MN receiving RTX therapy. Furthermore, SIRI emerges as a valuable prognostic indicator capable of predicting both short-term efficacy and long-term renal outcomes. These findings suggest that concurrent monitoring of B lymphocyte levels and SIRI values warrants integration into standardized monitoring frameworks within clinical management protocols.
Mucosal-associated invariant T cells and the gut-kidney axis: a review.
Zhang X, Wang J, He Y … +3 more , Xiao X, Fan J, Ma X
Clin Kidney J · 2026 Feb · PMID 41641316 · Full text
Mucosal-associated invariant T (MAIT) cells are a distinct subset of innate-like lymphocytes that bridge microbial homeostasis and tissue immunity. These evolutionarily conserved cells are activated via the recognition o...
Mucosal-associated invariant T (MAIT) cells are a distinct subset of innate-like lymphocytes that bridge microbial homeostasis and tissue immunity. These evolutionarily conserved cells are activated via the recognition of microbial metabolites presented by the MR1 molecule and establish stable residency in the kidney, where they profoundly influence local immune-metabolic processes. There is growing interest in the robust regulatory capacities of MAIT cells in renal physiology and pathology. This review systematically delineates their paradoxical roles in kidney diseases. Under specific conditions, they exert protective functions by suppressing inflammation and maintaining tissue homeostasis. Conversely, in distinct microenvironments, they adopt a pro-inflammatory phenotype, exacerbating pathological progression through the release of inflammatory cytokines and cytotoxic effector functions. The gut-kidney axis serves as a critical regulatory hub, wherein dysbiosis-derived signals can significantly amplify the renal impact of MAIT cells. Focusing on clinical translation, we provide an in-depth exploration of innovative strategies targeting MAIT cells, including adoptive cell therapy, receptor-targeting agents, and microbiome reconstruction. These approaches position MAIT cells as promising therapeutic targets for a new generation of immune-mediated kidney diseases.
Comparative renal safety: potassium-competitive acid blockers vs proton pump inhibitors.
Jang M, Kim S, Kim M … +6 more , Song SM, Jeon J, Jang HR, Lee JE, Huh W, Lee K
Clin Kidney J · 2026 Feb · PMID 41641315 · Full text
BACKGROUND: Proton pump inhibitors (PPIs) are associated with an increased risk of acute kidney injury and incident chronic kidney disease. Potassium-competitive acid blockers (P-CABs) have emerged as potent alternatives...
BACKGROUND: Proton pump inhibitors (PPIs) are associated with an increased risk of acute kidney injury and incident chronic kidney disease. Potassium-competitive acid blockers (P-CABs) have emerged as potent alternatives to PPIs, but their renal impact remains unclear. METHODS: This study compared renal outcomes between P-CAB and PPI in patients receiving either PPIs or P-CABs at a tertiary referral hospital in Korea between 2019 and 2023. Renal outcomes were defined as creatinine doubling and a decline in estimated glomerular filtration rate (eGFR) ≥50%, termed as "eGFR decline." We used Cox proportional hazard analyses to adjust for multiple covariates. RESULTS: The study included 1820 and 5121 patients in the P-CAB and PPI groups, respectively. The P-CAB group had lower incidences of creatinine doubling (13.4 vs 36.5, log-rank < .001) and eGFR decline (18.4 vs 39, log-rank < .001) than the PPI group (per 1000 person-years). Hazard ratios (HRs) for creatinine doubling and eGFR decline with P-CAB use were 0.42 [95% confidence interval (CI) 0.30-0.59, < .001] and 0.50 (95% CI 0.37-0.69, < .001), respectively. After adjusting multiple covariates, HRs were 0.52 (95% CI 0.37-0.74, < .001) for creatinine doubling and 0.63 (95% CI 0.46-0.87, = .005) for eGFR decline. CONCLUSIONS: P-CABs showed a lower risk of renal function decline compared with PPIs, suggesting that P-CABs may be a safer alternative for long-term acid suppression. Further studies incorporating other P-CABs and PPIs are needed to confirm these findings.
Untangling amino acid metabolism in renal diseases: mechanisms, dysregulation, and critical gaps.
Heneberg P, Heneberg Šimčíková D
Clin Kidney J · 2026 Feb · PMID 41641314 · Full text
Amino acid metabolism is closely linked with kidney physiology and pathology. In acute kidney injury, chronic kidney disease, diabetic kidney disease, and autosomal dominant polycystic kidney disease, disturbances in the...
Amino acid metabolism is closely linked with kidney physiology and pathology. In acute kidney injury, chronic kidney disease, diabetic kidney disease, and autosomal dominant polycystic kidney disease, disturbances in the branched-chain amino acids, tryptophan, glutamine, taurine, and sulfur amino acids pathways are consistently observed. Specific metabolites such as D-serine, kynurenine intermediates, and branched-chain keto acids are associated with disease progression. Taurine and indoxyl sulfate have also been proposed as therapeutic targets. At the nephron level, transporters and enzymes controlling amino acid flux influence nitrogen balance, oxidative stress, fibrosis, inflammation, and tubular injury. In chronic kidney disease, impaired amino acid handling contributes to protein-energy wasting, altered muscle metabolism, and systemic complications. In autosomal dominant polycystic kidney disease, cyst fluid metabolomics has revealed alterations in tryptophan and polyamine metabolism. The use of nutritional interventions, microbiome modulation, and selective supplementation as therapeutic strategies is being explored, although clinical trial evidence remains limited. Several key issues remain unresolved, including the need for isotope tracer studies to define renal amino acid kinetics in humans, the rigorous validation of metabolite biomarkers across diverse populations, the integration of diet and microbiome-derived metabolites into mechanistic frameworks, and the systematic evaluation of sex-specific differences. Longitudinal studies are scarce, thus restricting predictive power and therapeutic translation. Further mechanistic clarification may support the development of biomarkers and targeted therapies.
Dietary sodium reduction and blood pressure: a dose-response meta-analysis in hypertensive and chronic kidney disease patients.
Iwelomene O, Gougeon A, Burnier M … +4 more , Belot L, Sourd V, Fauvel JP, Granal M
Clin Kidney J · 2026 Feb · PMID 41635921 · Full text
BACKGROUND: Hypertension (HTN) is a leading risk factor for cardiovascular disease, and dietary sodium reduction is a cornerstone strategy for blood pressure (BP) control, particularly in vulnerable populations such as i...
BACKGROUND: Hypertension (HTN) is a leading risk factor for cardiovascular disease, and dietary sodium reduction is a cornerstone strategy for blood pressure (BP) control, particularly in vulnerable populations such as individuals with chronic kidney disease (CKD), who often present with HTN. This study aims to quantify the dose-response relationship between changes in sodium intake and changes in BP, through a meta-analysis of recent randomized controlled trials (RCTs) in individuals with CKD and with or without HTN. METHODS: A systematic literature search was conducted in PubMed, Cochrane Central and Embase databases to identify RCTs published since 2000 that evaluated the isolated effect of sodium intake modification on systolic and diastolic. Only trials estimating sodium intake via 24-h urinary sodium excretion were included to ensure accurate measurement of dietary intervention. A random-effects model was used to pool effect sizes, accounting for between-study heterogeneity. Linear, quadratic and cubic dose-response models were fitted and compared with identify the best-fitting relationship between sodium change and BP change. RESULTS: The analysis included 43 RCTs with 51 distinct population groups, involving 1759 subjects. The linear model best described the dose-response relationship in subjects with CKD, with or without HTN. A reduction in sodium intake of 40 mmol/day (approximately 2.4 g of salt) was associated with a mean systolic BP/diastolic BP reduction of -4.5 mmHg (95% confidence interval -5.8, -3.1)/-2.2 mmHg (-3.0, -1.3) in patients with CKD, -2.3 mmHg (-3.0, -1.6)/-1.1 mmHg (-1.5, -0.6) in patients with HTN and -0.3 mmHg (-0.5, -0.1)/-0.1 mmHg (-0.2, -0.1) in patients without HTN. CONCLUSION: Reducing sodium intake has a pronounced antihypertensive effect in patients with CKD and/or HTN. Regardless of the variability in effect according to BP status, adopting a low-salt diet represents good clinical practice and should be considered a standard prescription, particularly for individuals with CKD, as it supports better BP control and helps reduce cardiovascular risk.
Development and validation of the suicide risk score: a novel suicide risk prediction tool for patients with end-stage kidney disease.
Kim DG, Kim SH, Kang DR … +3 more , Nam SW, Lee JY, Lee J
Clin Kidney J · 2026 Feb · PMID 41635920 · Full text
BACKGROUND: Despite the high suicide rates among patients with end-stage kidney disease (ESKD), there is no suicide prediction model specifically designed for this vulnerable population. Herein, we aimed to develop and v...
BACKGROUND: Despite the high suicide rates among patients with end-stage kidney disease (ESKD), there is no suicide prediction model specifically designed for this vulnerable population. Herein, we aimed to develop and validate a novel suicide risk score for ESKD patients. METHODS: We analyzed data from the National Health Insurance Service (NHIS) of South Korea, including 251 819 patients aged above 18 years diagnosed with ESKD between 2007 and 2022 in South Korea. The mean follow-up duration was 6.6 years. The cohort was randomly divided into derivation (70%) and validation (30%) sets. Using multivariate Cox proportional hazard regression, key variables were incorporated to develop the suicide risk score, which was converted into a 48-point scoring system, which is composed of easily identifiable clinical parameters. RESULTS: Among 176 273 patients in the derivation cohort, 1126 (0.64%) patients committed suicide. The suicide risk score demonstrated moderate discrimination in both the derivation (C-statistic, 0.694) and validation (C-statistic, 0.709) cohorts, with good calibration. In the validation cohort, patients scoring below 16, 17-32 and 33-48 had predicted 10-year suicide risk of 0.2%, 1.2% and 7.7%, respectively, while the observed 10-year risk were 0.3%, 0.8% and 3.9%. These findings highlight the model's ability to effectively stratify risk using routinely available clinical data. CONCLUSIONS: The suicide risk score is a significant advancement in suicide risk prediction for ESKD patients. It is based on simple, routinely collected clinical indicators and provides an actionable tool for risk stratification and early intervention in daily practice.
Development and validation of a nomogram for predicting treatment failure in culture-negative peritoneal dialysis-associated peritonitis.
Niu L, Dou P, Wang Y … +7 more , Li F, Zhang D, Li J, Ma X, Fan C, Li X, Zhang Y
Clin Kidney J · 2026 Feb · PMID 41635919 · Full text
BACKGROUND: Culture-negative peritoneal dialysis-associated peritonitis (CNPDP) carries a high risk of treatment failure but lacks validated prediction tools. This study aimed to develop and validate a clinical nomogram...
BACKGROUND: Culture-negative peritoneal dialysis-associated peritonitis (CNPDP) carries a high risk of treatment failure but lacks validated prediction tools. This study aimed to develop and validate a clinical nomogram for individualized risk assessment of treatment failure in CNPDP patients. METHODS: In this multicenter retrospective study, 288 CNPDP patients treated at Jining Medical University Affiliated Hospital (2013-23) were randomly allocated to training ( = 173) and internal validation ( = 115) cohorts. An independent external cohort ( = 103) from Zaozhuang Municipal Hospital and Heze Municipal Hospital assessed generalizability. First, we used Random Forest to estimate missing data for variables with <30% missing values. Then, we used LASSO regression to analyze 32 candidate predictors. These predictors covered areas like patient demographics, clinical scores and lab test results. The final multivariate logistic regression model was visualized as a clinical nomogram. Performance was rigorously evaluated through area under receiver operating characteristic curve (AUC), calibration plots and decision curve analysis. The primary endpoint was composite treatment failure (catheter removal or peritonitis-related mortality ≤30 days). RESULTS: LASSO identified five independent predictors: effluent white blood cell count on Day 3 (Eff_WBC_D3), serum albumin (ALB), total cholesterol (TC), magnesium (Mg) and phosphorus (P). The nomogram achieved excellent discrimination: training cohort AUC = 0.897 (95% confidence interval 0.817-0.978), internal validation AUC = 0.861 (0.770-0.952) and external validation AUC = 0.849 (0.750-0.948) with minimal optimism (ΔAUC = 0.036). Eff_WBC_D3 demonstrated the strongest univariate predictive power (AUC = 0.830). Calibration curves showed optimal fit (Hosmer-Lemeshow = .32), while decision curve analysis confirmed clinical utility across probability thresholds of 5%-50%. For bedside implementation, an interactive web tool was developed (https://liuliangmianhua.shinyapps.io/dynnomapp/). CONCLUSION: This externally validated five-variable nomogram, deployed as a freely accessible online tool, offers a robust, practical tool for predicting treatment failure in CNPDP. Its integration of dynamic dialysate markers with routine laboratory data enables personalized early intervention and supports timely clinical decision-making.
Implementing a model of integrated CKD management between primary and secondary care.
Jones P, O'Keeffe H, Major RW … +4 more , Ritchie J, Sanganee N, Sinha S, Burton JO
Clin Kidney J · 2026 Jan · PMID 41608156 · Full text
Chronic kidney disease (CKD) is a common condition and important cardiovascular risk factor. However, CKD remains underdiagnosed and evidence-based medicines underutilized. In most healthcare systems, most CKD is managed...
Chronic kidney disease (CKD) is a common condition and important cardiovascular risk factor. However, CKD remains underdiagnosed and evidence-based medicines underutilized. In most healthcare systems, most CKD is managed in primary care. Optimal management in this setting can only be achieved with integration of care including early identification, prioritization, and use of the tools and skill mix available. This narrative review focuses on the importance of screening and identification in primary care, looking at innovative solutions and methods from other long-term conditions, particularly cardio-renal-metabolic conditions. Integrated care virtual multidisciplinary reviews, have demonstrated clinical and economic benefits, improved medication optimization, and reduced unnecessary referrals. However, implementation remains inconsistent, and prescribing of both established and novel therapies remains sub-optimal. Optimizing CKD care requires a system-wide approach that reinforces primary-secondary care collaboration, prioritizes early detection, and facilitates timely, evidence-based interventions. The inclusion of urine albumin: creatinine ratio testing, integrated digital tools, and shared accountability frameworks must be urgently adopted to realize improved outcomes and reduce the burden of CKD on individuals and healthcare systems alike.
Low protein diet with personalized support in advanced chronic kidney disease: association with disease progression, dialysis delay and mortality.
Vischini G, Caissutti S, Vetrano D … +8 more , Donini S, Mastromauro P, Chiocchini AL, Vella A, Magnoni G, Capelli I, Piccoli GB, La Manna G
Clin Kidney J · 2026 Jan · PMID 41608155 · Full text
BACKGROUND: Despite therapeutic strategies to manage comorbidities and risk factors associated with chronic kidney disease (CKD), a significant number of patients continue to progress toward kidney failure. The role of l...
BACKGROUND: Despite therapeutic strategies to manage comorbidities and risk factors associated with chronic kidney disease (CKD), a significant number of patients continue to progress toward kidney failure. The role of low protein diets (LPDs) in delaying the need for kidney replacement therapy (KRT) remains a subject of ongoing discussion. Real-world studies offer insights into the risks, implementation and feasibility of LPDs. METHODS: We retrospectively evaluated the efficacy of a moderate LPD (0.6-0.7 g/kg/day) proposed to all newly referred patients with advanced CKD. Survival and need for dialysis were compared between patients who choose an LPD and those who did not. Follow-up was otherwise identical in both groups. RESULTS: Between January 2021 and December 2023, 110 of 182 patients chose to follow an LPD, while 72 did not. No baseline difference in age, sex, kidney function and comorbidity were observed between the two groups. The decline in estimated glomerular filtration rate was faster in patients not adhering to a diet compared with those who followed it (-2.65 versus -0.89 ml/min/1.73 m/year), with an 84% reduction in the need for KRT {hazard ratio [HR] 0.16 [95% confidence interval (CI) 0.07-0.39]}, 78% in all-cause mortality [HR 0.22 (95% CI 0.06-0.72)] and 81% in the composite outcome death or dialysis [HR 0.19 (95% CI 0.09-0.38)]. CONCLUSION: When offered the option of an LPD, >60% of patients agreed to and followed it. Choosing an LPD was associated with improved patient and renal survival. While this retrospective study cannot establish a causal relationship, our data provide reassurance regarding feasibility and suggest potential advantages of offering LPDs to unselected patients with CKD who choose this dietary approach.
Serum proteome analysis detects early molecular signatures of disease progression in IgA nephropathy.
Chen TJ, Skandalou E, Fritz-Wallace K … +5 more , Apeland T, Knoop T, Marti HP, Eikrem Ø, Furriol J
Clin Kidney J · 2025 Dec · PMID 41607418 · Full text
BACKGROUND: Immunoglobulin A nephropathy (IgAN) is a common cause of chronic kidney disease (CKD) and identifying early molecular signatures is crucial for IgAN risk stratification and timely intervention. In this study...
BACKGROUND: Immunoglobulin A nephropathy (IgAN) is a common cause of chronic kidney disease (CKD) and identifying early molecular signatures is crucial for IgAN risk stratification and timely intervention. In this study we used serum proteomics to investigate molecular differences between IgAN patients who progressed and those who remained stable before separation in kidney function became apparent. METHODS: Serum samples from 40 adults with biopsy-proven IgAN were analysed and classified as progressors (PRs; = 13) or non-progressors (NPs; = 27) based on the estimated glomerular filtration rate slope over a 5- to 6-year follow-up. Samples underwent protein depletion, SP3 digestion, tandem mass tag labelling and liquid chromatography-tandem mass spectrometry analysis. Differentially expressed proteins were identified using Welch's -test. Enrichment analysis (Gene Ontology, Kyoto Encyclopedia of Genes and Genomes) was performed with ShinyGO and Cytoscape. Random forest machine learning was applied for classification modelling. RESULTS: Fifty-two proteins showed a significant differential abundance between PRs and NPs. Enrichment analysis revealed dysregulation in complement cascade, extracellular matrix signalling and renin-angiotensin system in PRs compared with NPs. Finally, the random forest model on this protein set achieved an accuracy of 85.0% and identified NCAM1, F7, ARG1, CLU and ANXA5 among the most important predictors. CONCLUSIONS: Serum proteomic profiling identified early molecular differences between PR and NP IgAN patients. These findings support the utility of serum proteomics for early risk stratification in IgAN.
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