Clinical Kidney Journal[JOURNAL]
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200 papers
Clinicopathologic features and outcomes of patients with DNAJB9-positive fibrillary glomerulonephritis.
Hurdogan O, Mirioglu S, Cebeci E … +9 more , Dirim AB, Bagbudar S, Karaoglan CS, Artan AS, Oto OA, Kilicaslan I, Ozturk S, Yazici H, Ozluk Y
Clin Kidney J · 2026 May · PMID 42311905 · Full text
BACKGROUND: Fibrillary glomerulonephritis (FGN) is a very rare glomerular disease characterized by non-branching fibril deposition and DNAJB9 positivity. We aimed to analyze our cohort to better elucidate clinicopatholog...
BACKGROUND: Fibrillary glomerulonephritis (FGN) is a very rare glomerular disease characterized by non-branching fibril deposition and DNAJB9 positivity. We aimed to analyze our cohort to better elucidate clinicopathologic features and outcomes of patients with FGN. METHODS: Adult patients diagnosed with FGN between 2007 and 2025 and showing DNAJB9 positivity were included. Primary composite outcome was defined as doubling of serum creatinine from baseline, undergoing dialysis or transplantation, development of stage 5 chronic kidney disease or death. RESULTS: Fifty native kidney biopsies of 44 patients were examined; 17 belonged to males (34%). Most common patterns of injury were mesangial (24, 48%) and membranoproliferative (16, 32%). Mean fibril diameter was 13.7 ± 2.5 nm. Eight biopsies (16%) showed atypical variants such as congophilia, light-chain restriction on frozen immunoflorescence and immunoglobulin G (IgG) negativity. Out of 44 patients, 25 (56.8%) had adequate follow-up data; the mean age was 48.4 ± 12.7 years. Over a median of 27 (7.5-89.5) months, 13 patients (52%) reached primary composite outcome, 10 (40%) underwent kidney replacement therapies and 3 (12%) died. Multivariate logistic regression models showed hemoglobin predicted the primary outcome whereas histopathological features or immunosuppressive use did not. Baseline serum C3 was associated with primary outcome (area under the curve 0.759, 0.525-0.916) with 134 mg/dL as cut-off value. The kidney survival rate was 30.8% in patients with serum C3 ≤134 mg/dL and 87.5% in serum C3 >134 mg/dL. However, multivariate regression models failed to show a clear association between serum C3 levels and primary outcome. CONCLUSIONS: Atypical histopathological features are not uncommon in FGN, complicating the differential diagnosis. Prognosis is still quite dismal despite immunosuppressive use. Lower baseline hemoglobin might indicate poorer outcomes.
Phosphate-latest news and ongoing trials.
Parpia AS, Kumra R, Mansell C … +4 more , Harel Z, Perl J, Ben-Bassat OK, Wald R
Clin Kidney J · 2026 May · PMID 42311904 · Full text
Hyperphosphatemia is present in nearly all patients with kidney failure who receive maintenance dialysis. The direct toxicity of elevated phosphate concentrations had been inferred from basic experimentation and large ep...
Hyperphosphatemia is present in nearly all patients with kidney failure who receive maintenance dialysis. The direct toxicity of elevated phosphate concentrations had been inferred from basic experimentation and large epidemiologic studies. This has influenced clinical practice in which great efforts are expended in normalizing serum phosphate concentration. Targeted dietary strategies, optimization of dialysis and phosphate-lowering medications are all effective at lowering serum phosphate levels yet each pose challenges for patients and clinicians. The effect of these interventions, individually and collectively, on patient-centered clinical outcomes is also unclear. We will review the evidence from clinical trials for each of these measures and discuss ongoing research that is testing optimal targets for serum phosphate.
Ten tips on how to prevent falls in dialysis patients.
Shirai N, Saitoh M, Tsubaki A … +4 more , Morishita S, Kojima S, Osawa Y, Yamamoto S
Clin Kidney J · 2026 Jun · PMID 42293367 · Full text
Falls are frequent and clinically significant events among patients undergoing dialysis and are associated with fractures, hospitalization, loss of independence, and increased mortality. Despite their clinical importance...
Falls are frequent and clinically significant events among patients undergoing dialysis and are associated with fractures, hospitalization, loss of independence, and increased mortality. Despite their clinical importance, fall prevention in this population remains challenging in routine practice because fall risk arises from a complex interaction between general geriatric factors and dialysis-specific conditions. This is a narrative review and proposes a conceptual framework that integrates general fall-related factors with dialysis-specific contributors and emphasizes the dynamic nature of fall risk over time. Because fall risk may fluctuate with changes in dialysis conditions, comorbidities, physical function, and activity levels, regular reassessment and longitudinal management are essential. While primarily based on evidence from hemodialysis patients, some aspects are considered applicable to peritoneal dialysis patients as well. Within this framework, we present 10 practical, clinically oriented tips to support fall prevention in patients undergoing dialysis. These tips address systematic risk assessment, monitoring of hemodynamic instability, individualized exercise and physical activity interventions, environmental and behavioral considerations after dialysis sessions, and the importance of multidisciplinary collaboration. By translating current evidence into actionable clinical guidance, this review aims to support clinicians in integrating fall risk assessment and prevention strategies into routine dialysis care. A structured, multidisciplinary, and continuously adaptive approach may help reduce falls and improve safety and functional outcomes in patients undergoing dialysis.
Measuring effectiveness in immunoglobulin A nephropathy: what are we looking for?
Barratt J, Floege J, Lafayette R … +4 more , Reich HN, Tesař V, Trimarchi H, Wadhwani S
Clin Kidney J · 2026 Jun · PMID 42293366 · Full text
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Fish oil supplements in patients with chronic kidney disease.
Ferro CJ, Thomas MR, Khattak S … +2 more , Chanouzas D, Townend JN
Clin Kidney J · 2026 Jun · PMID 42293365 · Full text
Cardiovascular disease (CVD) accounts for most of the increased morbidity and mortality associated with in chronic kidney disease (CKD). Cardiovascular risk emerges early in CKD, initially driven by atherosclerotic event...
Cardiovascular disease (CVD) accounts for most of the increased morbidity and mortality associated with in chronic kidney disease (CKD). Cardiovascular risk emerges early in CKD, initially driven by atherosclerotic events but later dominated by heart failure and sudden cardiac death. This transition reflects progressive arteriosclerosis and the development of CKD-associated cardiomyopathy. Although patients receiving dialysis experience the highest cardiovascular risk, established atherosclerotic therapies such as lipid-lowering agents offer limited benefit at this stage. Recent therapeutic advances, including SGLT2 inhibitors, GLP1 receptor agonists and mineralocorticoid receptor antagonists, have improved outcomes in non-dialysis CKD, but the high cardiovascular mortality of dialysis patients remains largely unchanged, with multiple interventions having failed to demonstrate benefit. In this review, we outline the pleiotropic actions of omega-3 polyunsaturated fatty acids (PUFA) including anti-inflammatory, anti-oxidative, anti-thrombotic, plaque stabilising and membrane modulating effects. We discuss the PISCES trial that reported large reductions in cardiovascular events with high dose fish oil supplementation (1.6 g EPA + 0.8 g DHA daily) in 1228 haemodialysis patients followed up for 3.5 years. This treatment lowered events comprising the primary endpoint by 43% with similar reductions observed in cardiac death, myocardial infarction and stroke. Prior studies of fish oils in CKD have been small and inconclusive, underscoring the need for further large, randomised trials to confirm efficacy. If validated, omega-3 PUFA therapy could represent a long-needed advance for improving cardiovascular outcomes in haemodialysis patients.
Hereditary kidney tumor syndromes: structured evaluation of a questionnaire-based approach.
Degenhardt J, von Zehmen T, Beck B … +4 more , Erger F, Heidenreich A, Müller RU, Paffenholz P
Clin Kidney J · 2026 Jun · PMID 42293364 · Full text
BACKGROUND: Up to 8% of renal tumors have a monogenic cause, yet hereditary renal cell carcinoma (hRCC) syndromes such as von Hippel-Lindau (VHL), Tuberous Sclerosis Complex (TSC), Birt-Hogg-Dubé (BHD), and Hereditary Le...
BACKGROUND: Up to 8% of renal tumors have a monogenic cause, yet hereditary renal cell carcinoma (hRCC) syndromes such as von Hippel-Lindau (VHL), Tuberous Sclerosis Complex (TSC), Birt-Hogg-Dubé (BHD), and Hereditary Leiomyomatosis and Renal Cell Cancer remain underdiagnosed. Early diagnosis is critical for patient management, genetic counseling, and family screening. We developed and prospectively validated a structured risk assessment tool (hRCC score) for identifying patients at risk of hereditary renal tumors. METHODS: A prospective single-center study was conducted at the University Hospital Cologne (2020-2022) including 200 patients with histologically confirmed renal tumors. The hRCC score incorporated age at diagnosis, multifocal/bilateral disease, histology, extrarenal manifestations, and family history. Patients with a score ≥1.5 were referred for genetic testing using a multiplex MLPA (Multiplex Ligand-dependent Probe Amplification)-based panel including , and . RESULTS: Of 195 eligible patients, 34.4% ( = 67) had a high-risk hRCC score (≥1.5). Overall, 71 (36.4%) underwent genetic testing; a pathogenic or likely pathogenic variant was detected in 50.7% of tested patients, corresponding to 18.5% of the total cohort. The most common diagnoses were TSC (58.3%), VHL (16.7%), and BHD (11.1%). Confirmed hereditary cases had significantly higher mean hRCC scores (4.67 vs 0.48, < .0001). Extrarenal manifestations and bilateral or multifocal disease were the strongest predictors. The cutoff of 1.5 yielded 97.2% sensitivity and 79.8% specificity. CONCLUSIONS: The hRCC score is an effective clinical screening tool for detecting patients at risk for hereditary renal tumors, demonstrating high diagnostic yield and supporting targeted referral for genetic evaluation.
Ascorbic acid as an adjunct therapy for anemia in erythropoietin-treated hemodialysis patients: a systematic review and meta-analysis.
Beltrán Covarrubias SA, Magallanes Bajana A, Chen Liang A … +10 more , Cruz Castillo Y, Villa Sánchez M, De la Rosa Valdez E, Sámano Sánchez M, Shambhavi S, Abbagoni V, Pena Zapata OY, Sanchez Cruz C, García-Erce JA, Calderón-Martínez E
Clin Kidney J · 2026 Jun · PMID 42246021 · Full text
BACKGROUND: Anemia is a common complication in chronic kidney disease (CKD), especially in hemodialysis patients, causing fatigue and reduced quality of life. Standard treatments involve iron and erythropoietin (EPO). As...
BACKGROUND: Anemia is a common complication in chronic kidney disease (CKD), especially in hemodialysis patients, causing fatigue and reduced quality of life. Standard treatments involve iron and erythropoietin (EPO). Ascorbic acid (vitamin C) supports iron metabolism by converting ferric to ferrous iron and enhancing absorption and mobilization. This systematic review and meta-analysis evaluated the effectiveness of ascorbic acid in improving hematologic and iron parameters in adult anemic patients undergoing maintenance hemodialysis. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was performed in PubMed, EMBASE, Cochrane, Scopus, Web of Science, CINAHL and Google Scholar through May 2025. Only randomized controlled trials and crossover studies assessing ascorbic acid in adult anemic hemodialysis patients were included. The protocol was registered in the International Prospective Register of Systematic Review (PROSPERO) (CRD420251056337). Primary outcomes were hemoglobin (Hb), ferritin, serum iron, transferrin saturation (TSAT) and total iron-binding capacity (TIBC). Meta-analyses used DerSimonian-Laird random-effects models. RESULTS: Of 479 screened articles, 14 studies were included. Ascorbic acid supplementation was associated with a modest but significant increase in Hb [mean difference (MD) 0.94 g/dL; 95% confidence interval (CI) 0.57 to 1.31; < .01; ² = 87.2%] and TSAT (MD 6.86%; 95% CI 1.93 to 11.78; < .01; ² = 96.7%). Ferritin levels showed a slight but significant reduction (MD -65.00 ng/mL; 95% CI -117.20 to -12.80; = .01; ² = 57.2%), along with a decrease in TIBC (MD -22.54 µg/dL; 95% CI -42.37 to -2.72; = .03; ² = 76.1%). EPO requirements expressed as units/kg/week were significantly reduced (MD -21.29; 95% CI -27.73 to -14.84; < .01; ² = 0.0%). No significant changes were observed in serum iron levels or EPO dosage expressed as IU/week. CONCLUSION: Ascorbic acid supplementation may confer modest hematologic benefits in hemodialysis patients with improvements in Hb, TSAT and iron utilization, and a small reduction in weight-adjusted erythropoiesis-stimulating agent dose. However, the certainty of evidence is low, and long-term safety and patient-centered outcomes remain unestablished.
Long-term B-cell depletion with rituximab in relapsing, refractory and severe lupus nephritis: a retrospective case series.
Wang Q, Efe O, Al Jurdi A … +6 more , Seethapathy H, Zonozi R, Sauvage G, Laliberte K, Niles J, Jeyabalan A
Clin Kidney J · 2026 Jun · PMID 42232596 · Full text
BACKGROUND: B-cell depletion with anti-CD20 agents has been evaluated as part of induction immunosuppression (IS) in lupus nephritis (LN). Data on its long-term efficacy for maintenance of remission remains limited. METH...
BACKGROUND: B-cell depletion with anti-CD20 agents has been evaluated as part of induction immunosuppression (IS) in lupus nephritis (LN). Data on its long-term efficacy for maintenance of remission remains limited. METHODS: Retrospective case series evaluating outcomes in patients with relapsing, refractory and severe LN at diagnosis who received rituximab (RTX)-induced continuous B-cell depletion for both induction and maintenance at Massachusetts General Hospital from 2008 to 2023. RESULTS: A total of 26 patients with active LN were included. Eighty-eight percent (23/26) had class III/IV ± V on kidney biopsy; 12% (3/26) had pure class V LN. Median follow-up (from first to last RTX) was 32 months [interquartile range (IQR) 14-68]; median cumulative dose of RTX was 10 g (IQR 6-17). At RTX initiation, all patients received prednisone and oral IS with an intention to taper off oral agents in 12 months. Eighty-one percent (21/26) achieved at least partial remission. Median prednisone dose decreased from 30 to 5 mg/day at 6 months ( < .01). Fifty-eight percent (15/26) of patients at 12 months and 79% (11/14) at 24 months were on RTX monotherapy. Six renal relapses occurred in five patients with median time-to-first relapse of 43 months (range 24-142); all episodes but one were preceded by B-cell repopulation. Five patients developed end-stage kidney disease; all had creatinine >2 mg/dL at RTX initiation. Thirty-one percent (8/26) experienced severe infections requiring hospitalization. No deaths occurred. CONCLUSION: Long-term continuous B-cell depletion may be an effective treatment strategy in patients with LN who have failed prior IS or with severe disease at diagnosis. Future controlled studies are needed to further evaluate this approach as the backbone therapy in LN.
Environmental footprint of peritoneal dialysis in Europe: a comparative life cycle assessment across four European centres.
Fehintola A, Jakubowska Z, Kepska-Dzilinska M … +19 more , Malyszko J, Crooijmans G, Thomas O, Larkin J, Ligabue G, Alfano G, Donati G, MartínezCadenas R, Yasar A, Sanz B, de Rivera GM, Cordero L, Audije-Gil J, Arenas MD, Steinbach I, Arias M, Ortiz A, Gerritsen K, Duane B
Clin Kidney J · 2026 Jun · PMID 42232595 · Full text
INTRODUCTION: Peritoneal dialysis (PD) is a home-based renal replacement therapy offering clinical and quality-of-life advantages, but it also poses environmental challenges due to resource use and waste generation. This...
INTRODUCTION: Peritoneal dialysis (PD) is a home-based renal replacement therapy offering clinical and quality-of-life advantages, but it also poses environmental challenges due to resource use and waste generation. This study compares the environmental impacts of PD across four European centres to identify regional sustainability differences and evaluate the footprint of continuous ambulatory (CAPD), automated (APD), and incremental (iPD) PD. METHODS: A cradle-to-grave life cycle assessment (LCA) was conducted for one year of PD treatment per patient using OpenLCA software and the EcoInvent database across four clinical centres; Madrid, Warsaw, Utrecht, Modena. Data were collected on material use, energy and water consumption, transportation, and waste disposal. Key indicators included global warming potential (GWP), energy use, water footprint. The environmental performance of each centre and dialysis modality was assessed. RESULTS: Environmental impacts varied significantly between centres ranging from GWP 3381 kg CO₂-eq to 1736 kg, reflecting differences in energy mix and efficiency. Energy consumption ranged from 54,710 MJ to 28,894 MJ and water footprint from 6631 m³ to 854 m³. Across all centres, CAPD and APD had higher environmental burdens than iPD. iPD reduced emissions by up to 50% and had a lower-impact profile. CONCLUSIONS: PD displays substantial environmental impact variability across centres, driven by differences in material consumption, waste management, energy sourcing, and clinical protocols. Cleaner energy profiles, effective waste management, and reduced reliance on single-use consumables may lower environmental burdens. These findings underscore the importance of integrating environmental performance into clinical decision-making and health system planning.
The utility and cost of embedding geriatric expertise in a tertiary referral renal clinic.
Aylett V, Relton SD, Rogers Z … +3 more , Howdon D, Winterbottom A, Mooney A
Clin Kidney J · 2026 Jun · PMID 42232594 · Full text
BACKGROUND: To address the changing demographic and increasing frailty and comorbidity of people referred to renal services, we initiated novel, routine, embedded, consultant-led, focused geriatric assessment of a select...
BACKGROUND: To address the changing demographic and increasing frailty and comorbidity of people referred to renal services, we initiated novel, routine, embedded, consultant-led, focused geriatric assessment of a selected group of patients in our Renal Low Clearance Clinic, seeking effects on treatment decision-making, patient outcomes and undertaking a health economic analysis. METHODS: A total of 133 patients fulfilling study-developed referral criteria received focused geriatric assessment. Short-term results (treatment decisions) of all 133 patients, plus long-term (survival) data for the first 77 patients for whom we have 3 years' follow-up are presented. Health economic analysis compared the cost of employing the Geriatrician versus avoiding unnecessary/futile dialysis access (arteriovenous fistula) creation based on historic rates in our own unit. RESULTS: Starting in 2018, 77 patients were reviewed before suspension enforced by the COVID-19 pandemic in March 2020, and a further 56 since resumption between July 2021 and January 2023 [mean age 78 (range 62-92) years; 70% male]. Following focused geriatric assessment, the number of patients undecided about treatment changed from 43 to 3; those choosing dialysis reduced from 80 to 44 and those choosing conservative management (CM) increased from 10 to 74. The number of advance care plans made increased from 0 to 77, and recorded resuscitation decisions from 6 to 42. Thirty-six months after focused geriatric assessment, the survival rate in the group choosing dialysis was 50% and in the CM group was 33%; most deaths were unrelated to renal failure and there was a trend towards clinical frailty scores impacting outcome more than treatment choice. Health economic analysis demonstrated that the costs of providing this review were more than offset by reductions in unnecessary/futile fistula formation. CONCLUSIONS: Routine, protocol-supported focused geriatric assessment in a tertiary referral renal service appears cost-effective and is associated with improved dialysis decision-making, advance care-planning and resuscitation decision-making.
Hemodiafiltration beyond the CONVINCE trial.
Strippoli GFM, Cromm K, Pezoulas VC … +9 more , Tachos N, Fotiadis DI, Jaure A, Malyszko J, Anger M, Fischer F, Hegbrant J, Nigwekar S, Kazancıoğlu R
Clin Kidney J · 2026 Jun · PMID 42232593 · Full text
Online hemodiafiltration (HDF) is a dialysis modality that can improve patient outcomes beyond those achieved with conventional high-flux hemodialysis (HD) in patients with kidney failure. The CONVINCE trial, the latest...
Online hemodiafiltration (HDF) is a dialysis modality that can improve patient outcomes beyond those achieved with conventional high-flux hemodialysis (HD) in patients with kidney failure. The CONVINCE trial, the latest and the largest of a series of randomized trials comparing HDF with HD, demonstrated a 23% reduction in the risk of all-cause mortality with high-volume HDF compared to high-flux HD. Systematic reviews of the totality of evidence confirmed cardiovascular and survival benefits of HDF. Further hard-endpoint trials are unlikely to change these findings. The challenge is implementation of these findings in clinical care. Nephrology is used to timeframes of 10-15 years before innovation gets implemented at the bedside, and this may well apply to HDF, particularly in regions where structural, regulatory, and financial barriers persist. In this narrative review, we discuss in broad terms the key items of a forward-looking research agenda for HDF after CONVINCE. Key priorities include real-world implementation studies; a strong focus on patient-reported outcomes; mechanistic research to understand why HDF is superior to HD and exploring personalized HDF regimens. Attaining these priorities will require leveraging innovative methods and we discuss two, target trial emulation methods and use of digital twin technologies. We aim to stimulate reflection and enthusiasm toward a modern approach to dialysis research that embraces innovation and centers on patient priorities. We advocate for world-class clinical guidelines on HDF, avoidance of opinion and position statements and a decisive, creative, and innovative research path. Patients with kidney failure deserve care informed by the best available evidence, implemented through rigorous guideline processes and adapted to patient preferences, health-system context, and feasibility.
Disparity in the regulation and prevention of water versus sodium imbalance in heat-stress nephropathy: a phylogenetic perspective.
Cirillo M, Zoccali C, Garofalo C … +6 more , Borrelli S, Ruotolo C, Marzano F, Minutolo R, De Nicola L, Conte G
Clin Kidney J · 2026 Jun · PMID 42232592 · Full text
The progressive rise in global temperature has led to an increase in heat-related illness and has brought heat-stress nephropathy (HSN) to the forefront as an emerging cause of both acute kidney injury (AKI) and chronic...
The progressive rise in global temperature has led to an increase in heat-related illness and has brought heat-stress nephropathy (HSN) to the forefront as an emerging cause of both acute kidney injury (AKI) and chronic kidney disease (CKD). HSN is characterized by tubulo-interstitial damage and linked to disturbances in water and sodium homeostasis. Observational studies indicate that young, otherwise healthy workers exposed to heat are less likely to develop AKI when hypovolaemia due to sweating is corrected with sodium chloride-containing solutions rather than water alone. This narrative review first summarizes the clinical spectrum, epidemiology, pathophysiology, and prevention of HSN in the context of climate change and the broader epidemic of heat-associated CKD described in several tropical and temperate regions. Then, it examines, in a phylogenetic perspective, the evolution of the two main regulatory systems governing body fluid homeostasis: the antidiuretic hormone (ADH)-thirst axis (water balance) and the renin-angiotensin-aldosterone system (RAAS)-salt appetite axis (sodium balance). In aquatic environments, large external osmotic gradients drove early renal adaptations primarily focused on water handling. Approximately 600 million years ago, ADH-like nonapeptides emerged, enabling tight regulation of plasma osmolality. With the transition to terrestrial life, the development of long loops of Henle, a hypertonic renal medulla, and exquisitely sensitive thirst mechanisms allowed mammals to conserve water very efficiently. By contrast, the RAAS system, central to sodium conservation and effective circulating volume, appeared later (around 400 million years ago) and remains slower and less sensitive, with no behavioural drive equivalent to thirst. The mineralocorticoid receptor is present in fish, but its specific ligand aldosterone first appears in terrestrial vertebrates. The net result is a phylogenetically more refined defence of water than of sodium. We propose that this evolutionary asymmetry underlies the particular renal vulnerability observed in HSN, in which inadequate sodium replacement and suboptimal control of volaemia may predispose to ischaemic tubular injury. Understanding these evolutionary roots may help explaining why, in the era of global warming, the prevention of HSN requires not only water but also appropriate salt replacement and targeted protection of vulnerable populations.
The environmental impact of routine laboratory testing in maintenance haemodialysis.
Tickell-Painter M, Woywodt A, Goolden C … +1 more , Shorten RJ
Clin Kidney J · 2026 Jun · PMID 42232591 · Full text
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Lifestyle intervention to reduce cardiovascular risk in kidney transplant recipients: the KT-LIFESTYLE multicentre randomized controlled trial.
Totti V, Tabanelli G, Stecchi M … +14 more , Brodosi L, Grandinetti V, Pizzuti V, D'Intino PE, Ferrarini D, Capelli E, Di Michele R, Mosconi G, Albertazzi V, Cordella E, Brigidi P, Morelli MC, La Manna G, Tarantino G
Clin Kidney J · 2026 Jun · PMID 42232590 · Full text
BACKGROUND: Kidney transplant recipients remain at high cardiovascular risk despite improved graft and patient survival. Physical inactivity, weight gain, and suboptimal dietary habits are common after transplantation an...
BACKGROUND: Kidney transplant recipients remain at high cardiovascular risk despite improved graft and patient survival. Physical inactivity, weight gain, and suboptimal dietary habits are common after transplantation and may contribute to this burden. METHODS: The KT-LIFESTYLE trial is a pragmatic, multicentre, prospective, open-label randomized controlled study designed to evaluate whether a structured lifestyle intervention can reduce cardiovascular risk in kidney transplant recipients. Participants will be randomized 1:1 to individualized exercise prescription plus tailored dietary counselling or standard lifestyle advice. The intervention combines multidisciplinary assessment, individualized exercise programming, motivational interviewing, and nutritional counselling integrated into routine transplant follow-up. The primary endpoint is the change in 10-year cardiovascular risk, assessed by the Framingham score over 36 months. Secondary outcomes include renal function estimated by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 equation estimated glomerular filtration rate, body composition, inflammatory markers, gut microbiota composition, health-related quality of life, adherence to physical activity and dietary counselling, hospital admissions, major adverse cardiovascular events, and all-cause mortality. CONCLUSIONS: KT-LIFESTYLE aims to provide evidence on the effectiveness and feasibility of a long-term lifestyle intervention after kidney transplantation. The study may also clarify the mechanisms through which lifestyle modification influences cardiovascular risk, inflammation, body composition, and gut microbiota in this population.Clinical trials registration number: NCT06806670.
Safety and clinical impact of SGLT2 inhibitor in patients undergoing peritoneal dialysis: a target-trial emulation study.
Chen YT, Wang CA, Chen JY … +1 more , Wu VC
Clin Kidney J · 2026 Jun · PMID 42232589 · Full text
OBJECTIVE: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve cardiovascular outcomes in chronic kidney disease, but their effects in peritoneal dialysis (PD) patients who are infection prone, remain unclear. STU...
OBJECTIVE: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve cardiovascular outcomes in chronic kidney disease, but their effects in peritoneal dialysis (PD) patients who are infection prone, remain unclear. STUDY DESIGN: The study design of this research is target-trial emulation using the global federated electronic health record database. Adults (18-90 years) with type 2 diabetes on PD for ≥3 months between February 2015 and June 2025 were included. Propensity score matching balanced SGLT2i and nonuser. Primary outcomes were all-cause mortality, severe sepsis, sepsis, and pneumonia; secondary outcomes included major adverse cardiovascular events (MACE) and PD-associated peritonitis. RESULTS: Among 29 529 eligible patients, 2815 (9.5%) received SGLT2i. After matching, 2749 patients were retained in each group with well-balanced baseline characteristics. Over a median follow-up of 0.79 years, SGLT2i users were associated with lower risks of all-cause mortality [adjusted hazard ratio (aHR) 0.818], severe sepsis (aHR 0.802), sepsis (aHR 0.661), pneumonia (aHR 0.664), and PD-associated peritonitis (aHR 0.340). MACE was not significantly different (aHR 0.798). SGLT2i was not associated with increased diabetic ketoacidosis, hypoglycemia, genital infection, volume depletion, or amputation. CONCLUSIONS: In this large real-world PD cohort with type 2 diabetes, SGLT2i use was associated with lower risks of death and major infections without safety concerns, supporting potential benefit pending randomized trial confirmation.
Abstract submissions to the ERA Congress: what they tell us about nephrology's trajectory.
Palladino G, Wanner C, Stevens K … +5 more , Mark PB, Tuglular S, Fontana M, Simon D, Ortiz A
Clin Kidney J · 2026 Jun · PMID 42232588 · Full text
submission trends to the ERA Congress provide a valuable lens through which to observe the evolution of nephrology research and education. Analysing submissions from 2020 to 2026, we document a marked recovery following...
submission trends to the ERA Congress provide a valuable lens through which to observe the evolution of nephrology research and education. Analysing submissions from 2020 to 2026, we document a marked recovery following the COVID-19 disruption, culminating in a record number of abstracts for the 2026 Congress in Glasgow. Beyond volume, notable shifts have occurred in subject mix, geographic participation and reviewer scoring patterns. Chronic kidney disease and glomerular disorders now dominate submissions, reflecting major scientific advances and changing clinical priorities, while international engagement has broadened substantially. These trends suggest that the ERA Congress has entered a new phase characterised by sustained high activity rather than transient post-pandemic rebound. We discuss the implications for congress programme design, peer review, inclusiveness and future strategic planning, highlighting how abstract data can inform the direction of large scientific meetings and the nephrology community at large.
Health-related quality of life in people with autosomal dominant polycystic kidney disease: a systematic review.
Gittus M, Zhang Y, Harnan S … +4 more , Sutton A, Fotheringham J, Ong ACM, Mandrik O
Clin Kidney J · 2026 Jun · PMID 42232587 · Full text
BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder and a major contributor to kidney failure worldwide. However, the impact of ADPKD on health-related quality of...
BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder and a major contributor to kidney failure worldwide. However, the impact of ADPKD on health-related quality of life (HRQoL) across chronic kidney disease (CKD) stages and kidney replacement therapies (KRT) is poorly understood. This study aimed to synthesize existing evidence on HRQoL as measured by patient-reported outcome measures (PROMs) in people with ADPKD, stratified by disease stage and KRT modality. METHODS: A systematic review was conducted using five databases (Medline, Embase, PsycINFO, CINAHL, Web of Science) and Google Scholar to identify studies published between January 2014 and October 2024. Eligible studies reported HRQoL in individuals with ADPKD using generic, kidney-specific, or ADPKD-specific PROMs Study populations were stratified by CKD stage and KRT modality. Scores were adjusted using country-specific population norms matched for age and sex, with population multipliers calculated to express patient-reported outcomes (PROs) as a proportion of the reference population. RESULTS: Six studies assessed PROs using the Short-Form-36/12 survey. Physical health worsened with CKD progression, corresponding to lower values relative to matched population norms. Mental health showed smaller deviations from population norms. Dialysis patients had the lowest physical health multipliers, while transplant recipients had better physical health it did not improve to early-stage CKD levels. Two studies using the EuroQual 5-Dimension tool had fewer notable differences between CKD stages. Kidney disease and ADPKD-specific scores showed more pronounced declines across CKD stages than generic PROMs, suggesting greater sensitivity to stage-related changes. CONCLUSIONS: This review demonstrates that PROs for individuals with ADPKD are lower in later CKD stages compared with earlier stages, with the largest effect on physical health. Mental health scores were less affected suggesting adaptation over time. Our findings suggest generic PROMs may underestimate the impact of ADPKD compared to disease-specific tools.
Randomized clinical trial of the KH4L self-management program.
Lambert K, O'Sullivan M, Dwyer KM … +2 more , Batterham M, Robson B
Clin Kidney J · 2026 Jun · PMID 42232586 · Full text
BACKGROUND: Chronic kidney disease (CKD) imposes physical, psychological, and social burdens. While self-management is essential in CKD, many existing interventions lack theoretical grounding and patient co-design. The K...
BACKGROUND: Chronic kidney disease (CKD) imposes physical, psychological, and social burdens. While self-management is essential in CKD, many existing interventions lack theoretical grounding and patient co-design. The Kidney Health 4 Life (KH4L) program was developed to address these gaps via a modular, online, peer-supported self-management intervention. METHODS: This open-label, single-blind, parallel group randomized controlled trial recruited Australian adults with CKD. Participants were randomized 1:1 to receive the KH4L intervention or standard care. The intervention consisted of six self-paced online modules, health coaching, and peer support. The primary outcome was self-management capability. Secondary outcomes included self-efficacy, knowledge, and psychological wellbeing. Outcomes were assessed at baseline, 6 weeks, and 18 weeks post baseline. Linear mixed models were utilized for quantitative outcomes and qualitative feedback was analysed using simple thematic analysis. RESULTS: Of 394 enrolled, 383 were included in the analysis. There was no significant change in the primary outcome of total self-management scores. However, the intervention group showed significant improvements in problem solving ( = .009), self-efficacy ( = .048), and CKD-related knowledge ( = .017). Mixed results were seen with the psychological outcomes with depression scores improving more in the control group ( = .043) and no improvement in anxiety. Subgroup analyses indicated greater benefits for those accessing CKD-specific modules compared to dialysis-specific content, possibly due to smaller sample size. CONCLUSIONS: KH4L improved some self-management outcomes in people with CKD. The findings highlight the value of tailored, stage-specific digital interventions and suggest theory-informed programs can improve self-efficacy and knowledge. Further research is needed to optimize engagement and ascertain long-term impacts.
Clonal hematopoiesis of indeterminate potential is associated with increased cardiovascular risk in chronic kidney disease.
Liu J, Luo S, Liu Z … +5 more , Wang T, Chen J, Gan H, Zhang D, Xiao J
Clin Kidney J · 2026 Jun · PMID 42232585 · Full text
BACKGROUND: Patients with chronic kidney disease (CKD) exhibit an extremely high prevalence of coronary artery disease. Clonal hematopoiesis of indeterminate potential (CHIP) and CKD share pathological features such as a...
BACKGROUND: Patients with chronic kidney disease (CKD) exhibit an extremely high prevalence of coronary artery disease. Clonal hematopoiesis of indeterminate potential (CHIP) and CKD share pathological features such as aging, chronic inflammation, and accelerated atherosclerosis. Their coexistence can synergistically exacerbate vascular damage and increase coronary risk. However, the association between CHIP and specific coronary lesions in CKD populations has not been reported, and its relationship with cardiovascular events remains controversial. METHODS: A total of 151 patients with CKD who underwent coronary angiography were prospectively included. To evaluate the status of CHIP, we utilized high-depth targeted sequencing, and measured serum inflammatory factor levels. Furthermore, we systematically followed up these patients to document the occurrence of adverse clinical events. RESULTS: CHIP was identified in 65 (43.0%) CKD patients, with the carrier rate steadily rising with age. The CHIP subjects had higher rates of left circumflex stenosis, three-vessel disease, and Gensini scores than non-CHIP patients (all < .05). After adjusting for relevant clinical risk factors, the presence of CHIP continued to show an independent association with three-vessel disease [odds ratio 2.26, 95% confidence interval (CI) 1.07-4.75; = .032]. The survival analysis indicated that CHIP, along with non- mutations and a larger clone size (variant allele frequency ≥0.10), correlated with the primary composite endpoint ( < .01). Even after controlling for various clinical variables, the CHIP status still demonstrated an independent association with the primary composite endpoint (hazard ratio 2.02, 95% CI 1.11-3.67; = .022). CONCLUSIONS: CHIP was associated with the severity of coronary lesions and unfavorable clinical outcomes in patients with CKD.
Combined occurrence of cardiovascular and bone events in individuals with kidney stone disease.
Ferraro PM, Taylor EN, Gambaro G … +1 more , Curhan GC
Clin Kidney J · 2026 May · PMID 42182979 · Full text
BACKGROUND: Kidney stone disease (KSD) has been linked to increased risk of adverse cardiovascular (CV) and bone events, raising the hypothesis of a shared pathogenic pathway. However, it is unclear whether these events...
BACKGROUND: Kidney stone disease (KSD) has been linked to increased risk of adverse cardiovascular (CV) and bone events, raising the hypothesis of a shared pathogenic pathway. However, it is unclear whether these events commonly occur in the same stone-forming individual. We examined the occurrence of CV and bone events in individuals with a history of KSD and analyzed their characteristics. METHODS: We analyzed three large prospective cohorts, the Health Professionals Follow-up Study (HPFS, men) and the Nurses' Health Study (NHS, women) I and II. Individuals with a self-reported diagnosis of KSD during follow-up and no previous CV or bone events at the time of KSD diagnosis were included in the study and followed until the development of a CV event (fatal or non-fatal myocardial infarction, coronary revascularization) and a bone event (fracture, osteoporosis); individuals who developed cancer or died were censored. Characteristics of stone formers experiencing only one event (CV or bone), both events, or none were compared using multinomial logistic regression models. RESULTS: Our study included data from 14 709 individuals with KSD. In HPFS, 28.7% of the participants experienced at least one event: 17.4% a CV event, 8.5% a bone event and 2.8% both. In NHS I, 46.0% of the participants experienced at least one event: 7.3% a CV event, 32.8% a bone event and 5.9% both. In NHS II, 27.1% of the participants experienced at least one event: 2.0% a CV event, 23.9% a bone event and 1.1% both. Across cohorts, age, BMI, thiazide use, calcium and vitamin D supplementation, and prevalence of hypertension and diabetes did not identify specific high-risk subgroups. CONCLUSION: CV and bone events are common in KSD; however, their co-occurrence in the same stone-forming individual is relatively rare. CV disease and bone disease are unlikely to share major risk factors in individuals with KSD.
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