Clinical Kidney Journal[JOURNAL]
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200 papers
Access to specialist palliative care and health care service utilization during the final year of life among patients with kidney disease.
Lehto HR, Wuorela M, Ahtiluoto S … +4 more , Nuutinen M, Saarto T, Carpén T, Akrén O
Clin Kidney J · 2026 May · PMID 42111897 · Full text
BACKGROUND: Despite the heavy symptom burden and progressive nature of non-malignant kidney diseases, access to palliative care services may be limited. We evaluated access to specialist palliative care (SPC), and its ef...
BACKGROUND: Despite the heavy symptom burden and progressive nature of non-malignant kidney diseases, access to palliative care services may be limited. We evaluated access to specialist palliative care (SPC), and its effect on health care utilization among patients with non-malignant and malignant kidney disease during their final year of life. METHODS: This retrospective cohort study examined causes of death among ≥18-year-old individuals in Finland in 2019 using the National Causes of Death Register. Data on access to SPC, emergency department contacts, and hospitalizations were collected from the National Care Register for the final year of life. RESULTS: Five hundred eighty-five patients had non-malignant kidney disease (54.8% females, mean age 84 years at the time of death) and 706 patients had malignant kidney disease (35.3%, 77.2 years, respectively). Of the patients with non-malignant kidney disease, only 54 (9.1%) had access to SPC services compared to 195 (27.6%) with malignant kidney disease ( < .001). Within patients with malignant kidney disease, those who had access to SPC died at home more often (10.6% vs. 5.9%; = .049), had fewer emergency department contacts (19.7% vs. 32.9%), and had a lower proportion of hospitalizations (16.4% vs. 37.2%; < .001) and readmissions to secondary care (4.6% vs. 10.6%; = .025) when compared to those without SPC access. No difference with regard to SPC access was seen among patients with non-malignant kidney disease. CONCLUSION: While SPC demonstrated benefits in malignant kidney disease patients' health care utilization, access was markedly limited for patients with non-malignant conditions, underscoring the need for improvements in service provision.
Dapagliflozin-associated correction of acute amphotericin B-induced hypomagnesemia.
Brand S, Udochukwu A, Chintalapati S … +2 more , Custodio MM, Shah CV
Clin Kidney J · 2026 May · PMID 42111896 · Full text
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Beyond traditional roles: vitamin D and erythropoietin as immune modulators in kidney diseases.
Magagnoli L, Bin S, Cravedi P … +1 more , Cozzolino M
Clin Kidney J · 2026 May · PMID 42111895 · Full text
Vitamin D and erythropoietin (EPO) are kidney-derived hormones classically known for their roles in mineral metabolism and erythropoiesis, respectively. Beyond these functions, growing evidence indicates that both molecu...
Vitamin D and erythropoietin (EPO) are kidney-derived hormones classically known for their roles in mineral metabolism and erythropoiesis, respectively. Beyond these functions, growing evidence indicates that both molecules exert broad immunomodulatory effects on innate and adaptive immunity. Vitamin D signalling through the vitamin D receptor shapes dendritic cell maturation, promotes regulatory T-cell induction, and suppresses pro-inflammatory T helper cell responses. Similarly, EPO acts as a pleiotropic cytokine capable of modulating macrophage activation, T-cell proliferation, and inflammatory signalling pathways through EPO receptor-dependent mechanisms. In chronic kidney disease (CKD), reduced renal synthesis of active vitamin D and impaired endogenous EPO production frequently coexist, contributing not only to disturbances in mineral metabolism and anaemia, but possibly also to immune dysregulation. Besides CKD, immune dysregulation is common across diverse nephrological conditions, including immune-mediated nephropathies and transplantation, where inflammatory and alloimmune responses critically influence disease progression and graft outcomes. Increasing experimental and clinical evidence suggests that vitamin D and EPO may modulate these processes and represent potential therapeutic targets. This narrative review summarizes current knowledge on the immunomodulatory properties of vitamin D and EPO, their mechanisms of action on immune cells, and their relevance in kidney disease and transplantation.
Nutcracker syndrome in 2026: a nephrologist-oriented diagnosis and management.
Mačionienė E, Kerpauskienė A, Žakauskienė U … +3 more , Vitkauskaitė M, Girčius R, Miglinas M
Clin Kidney J · 2026 May · PMID 42111894 · Full text
Nutcracker syndrome (NCS) refers to symptomatic compression of the left renal vein (LRV), most commonly between the aorta and superior mesenteric artery (anterior nutcracker) or, less frequently, between the aorta and ve...
Nutcracker syndrome (NCS) refers to symptomatic compression of the left renal vein (LRV), most commonly between the aorta and superior mesenteric artery (anterior nutcracker) or, less frequently, between the aorta and vertebral column in the presence of a retro-aortic LRV (posterior nutcracker). This venous entrapment elevates renal venous pressure and promotes drainage through the gonadal and pelvic venous networks. Clinical manifestations typically include haematuria, left flank or abdominal pain, orthostatic proteinuria, and features of gonadal or pelvic venous congestion such as varicocele. Diagnosis relies on careful clinical evaluation, exclusion of alternative aetiologies, and targeted imaging modalities including Doppler ultrasonography, computed tomography, magnetic resonance angiography, venography, and intravascular ultrasound. Despite increasing recognition of NCS, standardized diagnostic criteria and imaging thresholds remain lacking. Management strategies range from conservative treatment to endovascular interventions and open or laparoscopic surgical procedures. Optimal care requires a multidisciplinary approach involving urology, radiology, nephrology, and vascular surgery to ensure accurate diagnosis and individualized treatment planning.
Nocturnal hypertension in kidney transplant recipients: epidemiology, pathophysiology, prognostic significance, and management.
Georgiou A, Theodorakopoulou M, Iatridi F … +1 more , Sarafidis P
Clin Kidney J · 2026 May · PMID 42111893 · Full text
Kidney transplantation markedly improves survival and quality of life in patients with kidney failure; however, cardiovascular disease remains the leading cause of morbidity and mortality among kidney transplant recipien...
Kidney transplantation markedly improves survival and quality of life in patients with kidney failure; however, cardiovascular disease remains the leading cause of morbidity and mortality among kidney transplant recipients (KTRs). Hypertension after kidney transplantation is very common and is strongly associated with adverse cardiovascular as well as graft-related outcomes. Notably, hypertension in this population exhibits distinct features, including exceptionally high rates of masked hypertension; this is largely driven by the frequent occurrence of elevated nocturnal blood pressure (BP) and abnormal dipping patterns, which were observed in up to 95% of KTRs. Observational studies consistently demonstrate that higher nocturnal BP and abnormal dipping profiles are linked to accelerated graft function loss, cardiovascular events, and hypertension-mediated target-organ damage, frequently with stronger prognostic value than office or daytime BP measurements. In this review, we summarize the current evidence on circadian BP phenotypes and nocturnal hypertension in KTRs, focusing on epidemiology, underlying mechanisms, prognostic implications for cardiovascular and graft outcomes, and contemporary strategies for diagnosis and management.
At Europe's migration crossroads: dialysis outcomes and transplant access in patients immigrating to Belgium.
Jacobs L, Mesquita M, Taghavi M … +8 more , Verkest C, Paesmans M, Dumoulin B, Vieru E, Brayer I, Dratwa M, Nortier J, Collart F
Clin Kidney J · 2026 May · PMID 42111892 · Full text
BACKGROUND: Global inequities in dialysis and kidney transplantation among immigrant populations remain poorly characterized. At the crossroads of European migration, Brussels' Brugmann University Hospital provides an op...
BACKGROUND: Global inequities in dialysis and kidney transplantation among immigrant populations remain poorly characterized. At the crossroads of European migration, Brussels' Brugmann University Hospital provides an opportunity to examine outcomes in one of the most ethnically diverse dialysis cohorts in Western Europe, including a substantial proportion of undocumented immigrants. METHODS: We conducted a retrospective 15-year analysis of 497 incident dialysis patients (2010-2024), categorized as Western European (WE, 32%), Eastern European (EE, 21%), North African (NA, 26%), or Sub-Saharan African (SSA, 21%). Kaplan-Meier and Cox models assessed survival, while Fine-Gray competing-risk analyses evaluated transplant access. RESULTS: Despite language barriers, housing instability, and the frequent lack of legal residency, equitable dialysis delivery was achieved, with peritoneal dialysis implemented in 25%-30% of patients, including asylum seekers and undocumented immigrants. Median pre-dialysis nephrology follow-up was longer in WE (8 months) than in other groups (<1 month). Age (HR = 1.73) and comorbidity (HR = 1.62) independently predicted mortality, whereas ethnicity (HR = 0.77) reflected demographic rather than systemic disparities. Competing-risk analysis showed the highest transplant access among SSA patients (35%-40% at 10 years; sub-distribution hazard ratios) = 2.13, = .004), confirming that allocation was driven by clinical suitability rather than origin. CONCLUSION: In this uniquely multicultural setting, equitable access to dialysis and transplantation can be achieved across all immigrant groups, even among undocumented patients, but only when a dedicated hospital, social, and administrative structure is deliberately built to make it possible. The success of peritoneal dialysis among asylum seekers and the high transplant rates in SSA patients reflect an integrated system where equity is actively implemented, not assumed. These findings demonstrate that outcomes depend on clinical and organizational excellence rather than geography or migration status, offering a model for inclusive nephrology care in increasingly diverse European societies.
An early prediction model of steroid dependence or frequent relapses in nephrotic children: a multicentre retrospective cohort study in China.
Chen H, Zhang H, Li Y … +11 more , Yu S, Yang X, Wang A, Yang Q, Zhang F, Xiao L, Chen Z, Wang L, Li Q, Chan H, Yang H
Clin Kidney J · 2026 May · PMID 42111891 · Full text
BACKGROUND: Early identification and prediction of steroid-dependent/frequently relapsing nephrotic syndrome (SDNS/FRNS) in children have become increasingly important. The aim of this study was to develop and validate a...
BACKGROUND: Early identification and prediction of steroid-dependent/frequently relapsing nephrotic syndrome (SDNS/FRNS) in children have become increasingly important. The aim of this study was to develop and validate a model for the early identification and prediction of SDNS/FRNS in paediatric patients. METHODS: A multicentre retrospective study was conducted in China to investigate risk factors and develop a prediction model for the early identification of potential SDNS/FRNS in children with steroid-sensitive nephrotic syndrome (SSNS). Data were collected from 4259 children diagnosed with SSNS at the Children's Hospital of Chongqing Medical University between January 2009 and December 2023. After applying strict inclusion and exclusion criteria, 2624 cases were included in this study. The cohort was divided into two groups: the control group, comprising 1064 cases of non-SDNS/FRNS, and the experimental group, comprising 1560 cases of SDNS/FRNS. Both groups were further split into training and validation sets at an 8:2 ratio. Additionally, data from other nationwide multicentre studies conducted between 2012 and 2021 were gathered for external validation. RESULTS: This study identified 15 acute-phase clinical predictors of SDNS/FRNS development. Among the eight tested models, the LightGBM showed optimal performance [area under the curve (AUC) 0.89] when these features were used. The simplified 15-variable LightGBM model maintained strong external validation accuracy (AUC 0.93) and has been implemented in an online clinical tool for practical application. CONCLUSIONS: This work presents the first machine learning-based early prediction model for SDNS/FRNS using clinical big data from the acute phase of the condition. Additionally, it introduces an online prediction tool for paediatric SDNS/FRNS.
The epidemiology of end-stage kidney failure in France: reason for hope?
Couchoud C, Lassalle M, Gandoin AB … +2 more , Reydit MP, Vigneau C
Clin Kidney J · 2026 Apr · PMID 42111241 · Full text
BACKGROUND: Many European countries have experienced a decrease in the incidence of kidney replacement therapy (KRT), from as far back as 2008 for some. However, in France, the incidence increased by +0.8% annually from...
BACKGROUND: Many European countries have experienced a decrease in the incidence of kidney replacement therapy (KRT), from as far back as 2008 for some. However, in France, the incidence increased by +0.8% annually from 2005 to 2014. This study aimed to examine the recent trend in incidence of KRT in France and variations in different subgroups to understand the possible mechanisms involved. METHODS: To estimate the trend in KRT incidence for the French population, we used data from the Renal Epidemiology Information Network (REIN) registry, which has been available and comprehensive since 2012 for all of France. We estimated time trends from 2012 to 2023 by using a Joinpoint regression model that provides the annual percentage change and its confidence interval. We also analyzed the data by patient subgroups (age, comorbidities, etc.) or treatment conditions (emergency initiation, preemptive kidney transplantation, etc.). RESULTS: From 2012 to 2017, the number of new patients starting KRT increased annually by +2.7% in France, but the standardized incidence was stable. Since 2017, the number of new patients has been stable and the age- and sex-standardized incidence rate has decreased annually by 2.2%, likely due to the aging of the population. The reversal of the trend was particularly noticeable among older people and people with diabetes. Early mortality in people aged ≥75 years decreased significantly, which suggests that the most comorbid patients are now referred for conservative treatment. Even before the flat-rate payment system was introduced in 2019, more comprehensive and multidisciplinary care may have been developed for patients with stage 4-5 disease. CONCLUSION: In France, since 2017, the age- and sex-standardized KRT incidence rate decreased probably due to the combination of factors relating to changes in practices, the arrival of new treatments and changes in the general population.
Evaluation of a nurse-led chronic kidney disease clinic: a single-centre cohort study.
Wallace H, Wang Q, Simoni K … +3 more , Jun M, Crikis S, Nelson C
Clin Kidney J · 2026 Apr · PMID 42111240 · Full text
BACKGROUND: The objective of this study was to evaluate the clinical outcomes and patient satisfaction of a new nurse practitioner chronic kidney disease (CKD) clinic. METHODS: This was a prospective cohort study of all...
BACKGROUND: The objective of this study was to evaluate the clinical outcomes and patient satisfaction of a new nurse practitioner chronic kidney disease (CKD) clinic. METHODS: This was a prospective cohort study of all patients who had their first appointment with the early CKD nurse practitioner from October 2023 to October 2024, with data extracted on 1 April 2025. The outcomes were assessed across three domains: (domain 1) change in clinical outcomes of kidney function, albuminuria and blood pressure, (domain 2) prescription of guidelines concordant medications and (domain 3) patient satisfaction with care as assessed by a survey. RESULTS: There were 95 patients with a median age of 63 years [interquartile interval (IQI) 51-76], and 45.3% were female. Cardio-metabolic comorbidity was common; 82.8% of patients had hypertension, 55.6% diabetes and 25.2% cardiovascular disease. At referral the median urine albumin-creatinine ratio was 32.3 mg/mmol (IQI 11.2-53.5) and this was lower at discharge, 12.4 mg/mmol (IQI 2.9-25.3, < .001). Systolic and diastolic blood pressure were lower at discharge [mean difference mmHg (95% confidence interval, -value): 10.1 (6.58-13.54, <.001) and 5.2 (2.6-7.7, <.001), respectively]. There was no change in median estimated glomerular filtration rate. More patients at discharge were on a renin-angiotensin system inhibitor (88.4% versus 76.8%), sodium-glucose cotransporter 2 inhibitor (53.6% versus 28.4%), mineralocorticoid receptor antagonist (23.1% versus 5.2%) and glucagon-like peptide-1 receptor agonist (23.1% versus 9.6%). The survey response rate was 51.6% with patients reporting high satisfaction with the service. CONCLUSION: The CKD nurse practitioner clinic was effective at implementing guideline-directed medical therapies for early CKD and associated with improvements in blood pressure and albuminuria.
Heparin-induced thrombocytopenia: a challenging diagnosis in haemodialysis-state of art and review of the literature.
Capuano I, Riccio E, Buonanno P … +2 more , Tufano A, Pisani A
Clin Kidney J · 2026 Apr · PMID 42111239 · Full text
Heparin-induced thrombocytopenia (HIT) is a life-threatening disorder caused by exposure to heparin and characterized by high morbidity and mortality. It is largely underestimated because of its heterogeneous presentatio...
Heparin-induced thrombocytopenia (HIT) is a life-threatening disorder caused by exposure to heparin and characterized by high morbidity and mortality. It is largely underestimated because of its heterogeneous presentation, ranging from a decrease in platelet count antibody positivity to serious thrombotic complications. Haemodialysis (HD) patients represent a high-risk population due to anticoagulation use during extracorporeal treatments. It usually occurs in the first weeks after the start of HD, although it has been reported in chronic HD patients after surgery procedures. When the diagnosis of HIT is formulated, heparin must be promptly stopped and an alternative anticoagulant has to be started. The aim of this review is to provide a comprehensive overview on the pathogenesis, diagnosis and treatment of HIT in HD in order to increase the awareness of physicians of this important clinical syndrome to promptly start the specific treatment.
Ten tips on management of BK nephropathy in kidney transplant patients.
Geddes CC, Phelan PJ
Clin Kidney J · 2026 Apr · PMID 42111238 · Full text
Management of BK virus after kidney transplantation remains challenging, as recently published updated guidelines identify ongoing gaps in the evidence. In this article we present tips for management based on evidence an...
Management of BK virus after kidney transplantation remains challenging, as recently published updated guidelines identify ongoing gaps in the evidence. In this article we present tips for management based on evidence and clinical experience. Testing blood for BK virus by polymerase chain reaction should be part of the workup for any patient with significant deterioration in kidney transplant function. All kidney transplant biopsies should be tested by immunohistochemistry for the presence of SV40 large T antigen if there are features of tubulointerstitial inflammation on light microscopy. A transplant kidney biopsy that does not include medulla does not exclude BK virus-associated nephropathy (BKVAN). Tubulointerstitial inflammation with positive SV40 staining and undetectable BK virus in the blood implies a different polyomavirus nephropathy such as JC virus. Clinicians should consider the evidence carefully before deciding whether or not to adopt a BK viraemia screening strategy in their unit. If a strategy of screening for BK viraemia in the absence of transplant dysfunction is adopted, then it makes sense to target the first year and for screening to be at least every 4 weeks. The optimal reduction in immunosuppression in response to BK viraemia or BKVAN has not been established by clinical trials. A rapid decline in BK viral load after reduction in immunosuppression appears to be a strong risk factor for impending T cell-mediated rejection. Clinical trials of the addition of potentially effective anti-polyomavirus agents including leflunomide, fluoroquinolones, intravenous immunoglobulin concentrate, cidofovir and statins have not shown benefit. BK viraemia or BKVAN recurrence after viral clearance is rare.
Elevated serum TMAO levels associate with higher risk of arteriovenous vascular access thrombosis in hemodialysis patients.
Chen MK, Chang YC, Chou AK … +5 more , Hsieh MY, Kuo CH, Huang PH, Lai TJ, Wu CC
Clin Kidney J · 2026 May · PMID 42100718 · Full text
BACKGROUND: Arteriovenous access thrombosis is a major cause of morbidity in patients receiving maintenance hemodialysis, and conventional clinical and anatomical risk factors do not fully explain its occurrence. Trimeth...
BACKGROUND: Arteriovenous access thrombosis is a major cause of morbidity in patients receiving maintenance hemodialysis, and conventional clinical and anatomical risk factors do not fully explain its occurrence. Trimethylamine--oxide (TMAO), a gut microbiota-derived metabolite that accumulates in kidney failure and exhibits prothrombotic properties, has been linked to cardiovascular events in dialysis populations. Its relevance to dialysis arteriovenous access outcomes, however, remains unclear. METHODS: We conducted a multicenter prospective cohort study including 375 adult patients undergoing maintenance hemodialysis at 12 centers in Taiwan. Baseline serum TMAO concentrations were measured using liquid chromatography-tandem mass spectrometry and analyzed as tertiles and as a log-transformed continuous variable. Participants were followed for a median of 24 months. The primary outcome was time to first arteriovenous access thrombosis. Associations were evaluated using Cox proportional hazards models with multivariable adjustment and restricted cubic spline analyses. RESULTS: During a median follow-up of 24 months, 88 patients (23%) experienced arteriovenous access thrombosis. Thrombosis incidence increased stepwise across TMAO tertiles (13%, 23%, and 34%; < .001). In unadjusted analysis, patients in the highest TMAO tertile had a higher risk of thrombosis compared with the lowest tertile [unadjusted hazard ratio 3.10; 95% confidence interval (CI): 1.75-5.51]. This association remained significant after multivariable adjustment (adjusted hazard ratio 2.87; 95% CI 1.60-5.17). Results were consistent in competing-risk analyses treating death as a competing event. Addition of TMAO to a baseline clinical model yielded modest improvement in discrimination (ΔC = 0.011, 95% CI: -0.047 to 0.070; = .051). CONCLUSION: Higher serum TMAO levels were independently associated with an increased risk of arteriovenous access thrombosis in patients undergoing hemodialysis. These findings suggest that TMAO reflects a systemic prothrombotic milieu relevant to dialysis arteriovenous access and support further studies to determine whether TMAO represents a modifiable pathway or a biomarker of uremic thrombotic susceptibility.
Interpreting the PISCES trial on fish oil in hemodialysis patients: lessons on trial design, biological exposure, and outcome measurement.
Mazón-Ruiz J, de Cos Gomez M, González Bores P … +1 more , Corral P
Clin Kidney J · 2026 May · PMID 42100717 · Full text
Patients receiving maintenance hemodialysis experience an exceptionally high cardiovascular risk, characterized by frequent recurrent events and a longstanding lack of effective preventive therapies. Most cardiovascular...
Patients receiving maintenance hemodialysis experience an exceptionally high cardiovascular risk, characterized by frequent recurrent events and a longstanding lack of effective preventive therapies. Most cardiovascular trials in this population have yielded neutral results, highlighting important limitations in both therapeutic strategies and outcome assessment. The PISCES trial recently reported significant reductions in both first and recurrent cardiovascular events with high-dose omega-3 fatty acids in patients undergoing hemodialysis, using a recurrent-event framework to capture overall cardiovascular burden. In this focused narrative review, we critically appraise the PISCES findings within the broader context of omega-3 research in chronic kidney disease and dialysis. Particular emphasis is placed on how biological exposure, population selection, and outcome frameworks influence the detectability of cardiovascular benefit in high-risk populations. PISCES challenges the prevailing notion that cardiovascular risk in hemodialysis is largely unmodifiable and underscores the importance of aligning therapeutic interventions with outcome measures that reflect total disease burden. More broadly, the trial illustrates how methodological choices may critically influence the interpretation of cardiovascular efficacy in populations with dense event clustering and high competing mortality.
Validation of albuminuria as a surrogate endpoint in chronic kidney disease: clinical context and implications.
Matyjek A, Fernández-Fernández B
Clin Kidney J · 2026 May · PMID 42100716 · Full text
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Ten tips for ordering, interpreting, and communicating genetic test results in nephrology.
Selvathesan N, Costigan CS, Bahadori A … +1 more , Lemaire M
Clin Kidney J · 2026 May · PMID 42100715 · Full text
Genetic testing is becoming a routine-and increasingly time-sensitive-tool in nephrology, with implications for diagnosis, prognosis, targeted therapy, transplant planning, and family counselling. However, many nephrolog...
Genetic testing is becoming a routine-and increasingly time-sensitive-tool in nephrology, with implications for diagnosis, prognosis, targeted therapy, transplant planning, and family counselling. However, many nephrologists remain uncomfortable with genetic concepts in general, and variant interpretation specifically. This gap will increasingly limit their ability to fully leverage genetic testing in routine nephrology care-and to translate results into management decisions that improve patient outcomes. In this review, we provide 10 practical tips to help nephrologists integrate genetic testing safely and confidently into everyday practice. We emphasize early testing when a molecular diagnosis could plausibly change management, and the primacy of careful phenotyping (including extra-renal features) to guide efficient test selection (single-gene testing, targeted panels, exome, or genome). We outline a pragmatic approach to informed consent that addresses the family impact, secondary findings, and the possibility of misattributed parentage. We then walk through how to read genetic reports, recognize common technical 'blind spots' (e.g. copy number variants), and classify results in a clinically meaningful way (diagnostic, suggestive, or uninformative). We highlight how to handle variants of uncertain significance as hypotheses rather than diagnoses, and why periodic reanalysis is essential as gene-disease assertions and variant classifications evolve. Finally, we encourage clinicians to work within multidisciplinary pathways and to contribute to data-sharing efforts that advance nephrogenetics. Each tip concludes with a brief 'nephrogenetics nugget'-a practical takeaway, a useful metaphor, or a simple script-to help clinicians translate core concepts into real-world conversations and decisions at the point of care. Overall, these tips provide a practical framework for ordering, interpreting, and disclosing genetic test results in routine nephrology care.
Unveiling the silent burden: high prevalence of occult nephropathies in radical nephrectomy specimens.
Fenoglio R, Mantovani E, Cortazzi S … +5 more , Barreca A, Graziano M, Bardari F, Sciascia S, Roccatello D
Clin Kidney J · 2026 May · PMID 42100714 · Full text
BACKGROUND: Chronic kidney disease (CKD) and renal cell carcinoma share a bidirectional relationship, with radical nephrectomy posing a significant risk for postoperative renal decline. This study identifies radical neph...
BACKGROUND: Chronic kidney disease (CKD) and renal cell carcinoma share a bidirectional relationship, with radical nephrectomy posing a significant risk for postoperative renal decline. This study identifies radical nephrectomy as a critical opportunity to evaluate the non-neoplastic renal parenchyma. METHODS: We conducted a prospective observational study on 30 adult patients diagnosed with renal or urothelial cancer who underwent radical nephrectomy. Samples of non-neoplastic renal parenchyma were collected during surgery and analyzed using optical microscopy and immunofluorescence. Renal function was assessed pre- and postoperatively using the CKD-EPI formula. RESULTS: The cohort comprised 30 patients (63.3% male) with a median age of 65.5 years (min 29-max 83). Following radical nephrectomy, 50% of patients with preserved preoperative renal function experienced a decline to estimated glomerular filtration rate < 60 ml/min/1.73 m². Histopathological evaluation of the non-neoplastic parenchyma revealed chronic tubulointerstitial damage in 41% ( = 12) and arteriosclerotic vascular damage in 38% ( = 11) of cases. Notably, occult nephropathies were identified in 24% ( = 7) of the cohort, comprising diabetic glomerulosclerosis ( = 2), membranous nephropathy ( = 2), fibrillary glomerulonephritis ( = 1), IgA nephropathy ( = 1), and minimal change disease ( = 1). Two cases (IgA nephropathy and minimal change disease) demonstrated spontaneous remission postsurgery, consistent with a paraneoplastic etiology. CONCLUSIONS: The non-neoplastic renal parenchyma in renal cell carcinoma patients frequently exhibits occult pathological changes, predominantly tubulointerstitial damage likely driven by the tumor microenvironment. The study highlights a higher-than-expected prevalence of undiagnosed nephropathies (24%), including paraneoplastic cases. Routine histological evaluation during radical nephrectomy is essential for optimizing patient management, avoiding unnecessary subsequent biopsies, and guiding therapeutic decisions in the oncological setting.
Immunogenicity and reactogenicity of the adjuvanted respiratory syncytial virus vaccine in patients with chronic kidney disease.
Radun R, Bronder S, Abu-Omar A … +3 more , Fliser D, Sester M, Schmit D
Clin Kidney J · 2026 May · PMID 42100713 · Full text
BACKGROUND: Chronic kidney disease (CKD) contributes to global mortality and morbidity, also due to infectious complications resulting from immune system dysregulation. Recently, respiratory syncytial virus (RSV) vaccine...
BACKGROUND: Chronic kidney disease (CKD) contributes to global mortality and morbidity, also due to infectious complications resulting from immune system dysregulation. Recently, respiratory syncytial virus (RSV) vaccines based on the prefusion F (preF) glycoprotein have been licensed for prevention of severe disease in elderly and in patients with comorbidities, but data on immunogenicity in patients with CKD are scarce. METHODS: We characterized humoral and cellular immunogenicity of 75 patients with CKD stages G3a to G5d both before and 14 days (IQR 2) after vaccination with an adjuvanted protein-based RSVpreF3-vaccine using ELISA and flow cytometry. Data on adverse events were collected through a self-reported questionnaire. RESULTS: Vaccination led to a significant induction of RSV-specific CD4 T cells ( < .0001) and the increase did not differ between the CKD stages. CD8 T cells were not specifically induced. Despite high seroprevalence prior to vaccination, quantitative levels of RSV-specific immunoglobulins IgG and F protein-specific IgG were significantly induced on vaccination (both < .0001), with a less pronounced increase in patients with advanced CKD. Urinary albumin-creatinine-ratio (UACR) was shown to be predictive of vaccine response in a multivariate regression model using age, serum creatinine and urea as covariates ( = .035). The vaccine was well tolerated with mostly transient adverse events at the injection site. CONCLUSIONS: RSV-vaccination led to a robust CD4 T-cell and humoral response in patients with CKD with less pronounced effects in those with high-grade proteinuria. Long-term data on immunogenicity and correlation with clinical outcomes are warranted to define optimal vaccination strategies.
Constipation prevalence and its association with kidney function: a large nationwide Japanese health check-up cohort study.
Hirano K, Sumida K, Fukuma S
Clin Kidney J · 2026 May · PMID 42100712 · Full text
BACKGROUND: Constipation is one of the most common gastrointestinal disorders in the general population. However, its prevalence in patients with chronic kidney disease (CKD) and its association with kidney function have...
BACKGROUND: Constipation is one of the most common gastrointestinal disorders in the general population. However, its prevalence in patients with chronic kidney disease (CKD) and its association with kidney function have not been comprehensively examined. METHODS: Using nationwide annual health check-ups and medical claims data collected in Japan from 2015-2023, we identified a total of 903 984 person-year observations from 217 734 unique individuals aged 20-74 years with available estimated glomerular filtration rate (eGFR) data. We evaluated the prevalence of constipation, defined by diagnostic codes or laxative use, and patterns of laxative prescriptions overall and across eGFR categories. Multivariable logistic regression models were used to assess the cross-sectional association between eGFR and constipation, adjusting for demographics, vital signs, comorbidities, and medication use. RESULTS: Participants were 49.5 (SD, 10.4) years old, 72% were male, and 12.1% had diabetes. Among the 903 984 person-year observations, 87,861 (9.7%) had constipation. The prevalence of constipation was higher with lower eGFR, with 9.4%, 13.1%, 20.3%, 25.3%, and 45.2% in participants with eGFR ≥60, 45-59, 30-44, 15-29, and <15 ml/min/1.73 m², respectively. Laxative prescription patterns differed by CKD stages, with less use of magnesium salts and greater use of novel agents in more advanced CKD stages. After multivariable adjustment, compared with eGFR ≥60 ml/min/1.73 m², lower eGFR was significantly associated with a higher odds of constipation in a graded manner [adjusted odds ratios (95% CI), 1.07 (1.04-1.11), 1.14 (1.03-1.25), 1.47 (1.20-1.79), and 2.44 (1.84-3.22), respectively]. CONCLUSION: Constipation was prevalent in patients with CKD. Lower kidney function was independently associated with higher odds of constipation, with the highest odds seen in the most advanced stage of CKD. These findings highlight the real-world burden of constipation across the CKD spectrum and suggest a potential pathophysiological link between constipation and impaired kidney function.
The ERA Registry Annual Report 2023: epidemiology of kidney replacement therapy in Europe, with a focus on age comparisons.
Hoekstra MWF, Boenink R, Bonthuis M … +36 more , Boerstra BA, Astley ME, Montez de Sousa IR, Gjorgjievski N, Resic H, Mitsides N, Hommel K, Guidotti R, Marín Sánchez I, Slon-Roblero MF, Artamendi M, Beckerman P, Buchwinkler L, Gellert R, Kuzema V, Okša A, Comas J, Heylen LMTJ, Lassalle M, Hernandez Ramirez S, Santhakumaran S, Seyahi N, Åsberg A, Weekers LE, Muñoz-Terol JM, Trujillo-Alemán S, Memeti Smaili F, Ots-Rosenberg M, Indridason OS, Komissarov KS, Ten Dam MAGJ, Stendahl M, Galvão AA, Ortiz A, Stel VS, Kramer A
Clin Kidney J · 2026 May · PMID 42100711 · Full text
The European Renal Association (ERA) Registry collects data on patients with kidney failure receiving kidney replacement therapy (KRT). This paper presents a summary of the ERA Registry Annual Report 2023, and focuses sp...
The European Renal Association (ERA) Registry collects data on patients with kidney failure receiving kidney replacement therapy (KRT). This paper presents a summary of the ERA Registry Annual Report 2023, and focuses specifically on comparisons by age. The complete ERA Registry Annual Report 2023 is available in the Supplementary information. For 2023, data were collected from 34 countries in Europe and countries bordering the Mediterranean Sea. Using these data, incidence and prevalence of KRT, kidney transplantation rates, survival probabilities, and expected remaining lifetimes were calculated. In 2023, the ERA Registry covered 519 million people in the participating countries. The incidence of KRT was 151 per million population (pmp). Among incident patients, 29% were aged ≥75 years, 64% were male, and the most common primary renal disease (PRD) was diabetes mellitus (22%). Most patients (83%) started KRT with haemodialysis (HD), 11% started with peritoneal dialysis (PD), and 6% underwent pre-emptive kidney transplantation. On 31 December 2023, the prevalence of KRT was 1101 pmp. Among prevalent patients, 24% were aged ≥75 years, 62% were male, and the most common PRD was of miscellaneous origin (18%). Moreover, 56% of prevalent patients received HD, 5% received PD, and 39% were living with a functioning graft. In 2023, the kidney transplantation rate was 43 pmp, with 69% of kidneys coming from deceased donors. For patients starting KRT between 2014 and 2018, 5-year survival probability was 51%. The proportions of incident and prevalent patients aged ≥75 varied considerably across European countries. In addition, incident patients aged ≥75 were more often male, and had more often hypertension as PRD compared with younger patients. Only 1% of incident patients aged ≥75 received a pre-emptive kidney transplant, while among prevalent patients of the same age, 22% was living with a functioning graft.
Repeat kidney biopsy in patients with ANCA-associated vasculitis and suspected kidney relapse.
Braud P, Clech AL, Couvrat-Desvergnes G … +7 more , Dimet J, Moreau A, Renaudin K, Benard L, Néel A, Ville S, Ronsin C
Clin Kidney J · 2026 Mar · PMID 42100366 · Full text
BACKGROUND: The role of repeat kidney biopsy in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with suspected renal relapse remains uncertain. Clinical indicators such as hematuria, proteinuria an...
BACKGROUND: The role of repeat kidney biopsy in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with suspected renal relapse remains uncertain. Clinical indicators such as hematuria, proteinuria and ANCA reappearance often guide therapy but may not reliably distinguish active vasculitis from chronic damage. Repeat biopsy may also provide prognostic information in patients with prolonged immunosuppressive exposure. METHODS: We retrospectively analyzed adults with biopsy-proven AAV who underwent a second kidney biopsy (KB2) for suspected renal relapses. Clinical, laboratory and histopathologic data from the first (KB1) and KB2 were reviewed. Dynamic variations in ANCA, hematuria and proteinuria between 6 months post-KB1 and -KB2 were assessed for their association with histologic activity. RESULTS: Forty patients were included; 25 (62%) had histologically active vasculitis on KB2, whereas 15 (38%) showed inactive lesions. Active disease was associated with the presence ( = .001) and higher levels of hematuria [100 (92-100) vs 14 (4-46) cells/mm³, < .0001] and proteinuria [1.55 (1.0-3.30) vs 0.89 (0.44-1.53) g/g, = .046]. Longitudinally, ANCA and hematuria reappearance were associated with active vasculitis in 68% and 80% of cases, respectively, whereas proteinuria rise was not. Repeat biopsies showed a shift from proliferative to sclerotic lesions, with increased glomerulosclerosis and interstitial fibrosis; the degree of glomerulosclerosis inversely correlated with renal recovery at 6 months. CONCLUSION: Clinical and laboratory findings alone often overestimate renal relapses. Dynamic changes in ANCA and hematuria improve prediction but remain insufficient to replace biopsy confirmation, which provides essential diagnostic and prognostic information in relapsing AAV.
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