Clinical Kidney Journal[JOURNAL]
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200 papers
Ten tips on how to prevent and manage post-transplant lymphoproliferative disease in kidney transplant recipients.
Attieh RM, Ghobadi A, Murakami N
Clin Kidney J · 2026 Apr · PMID 42038164 · Full text
Post-transplant lymphoproliferative disease (PTLD) remains a challenging and high-impact complication of kidney transplantation, requiring thoughtful prevention, timely recognition, and multidisciplinary management. Key...
Post-transplant lymphoproliferative disease (PTLD) remains a challenging and high-impact complication of kidney transplantation, requiring thoughtful prevention, timely recognition, and multidisciplinary management. Key strategies include careful selection of immunosuppressive regimens, particularly avoiding belatacept in Epstein-Barr virus (EBV)-seronegative recipients and exercising caution with lymphodepleting induction in EBV-mismatched pairs, along with targeted EBV surveillance in high-risk patients. Once PTLD is suspected or confirmed, accurate staging and a stepwise treatment approach beginning with reduction of immunosuppression and escalating to rituximab, chemotherapy, or advanced cellular therapies are essential, with EBV-CTLs and chimeric antigen receptor T-cell therapy offering promising options in refractory disease. Close monitoring for infectious complications, cytopenias, and rejection is critical throughout treatment. Importantly, a prior history of PTLD should not preclude future transplantation in appropriately selected patients with sustained remission. Continued research is needed to refine surveillance strategies, clarify optimal treatment sequencing, and improve long-term outcomes for kidney transplant recipients at risk for or affected by PTLD.
Lower limb amputation in incident dialysis patients in England: incidence, outcomes and inter-centre variation from a national registry study.
Bodapati N, Masoud S, Peracha J … +8 more , Pitcher D, Casula A, Steenkamp R, Medcalf J, Nitsch D, Rayman G, McKane W, Lipkin G
Clin Kidney J · 2026 Apr · PMID 42038163 · Full text
BACKGROUND: Lower limb amputation (LLA) is a devastating complication in dialysis patients, often related to diabetes and peripheral vascular disease. National data on LLA incidence, variation and outcomes in England are...
BACKGROUND: Lower limb amputation (LLA) is a devastating complication in dialysis patients, often related to diabetes and peripheral vascular disease. National data on LLA incidence, variation and outcomes in England are limited. METHODS: A retrospective cohort study conducted using linked data from the UK Renal Registry (UKRR) and Hospital Episode Statistics for incident dialysis patients in England (2003-17). Cumulative incidence plots assessed LLA rates across three patient subgroups: primary renal disease (PRD) diabetes, diabetes as comorbidity and no diabetes. Fine-Gray competing risk models identified independent risk factors for LLA. One-year mortality following LLA was presented as Kaplan-Meier curves and analysed using age- and sex-adjusted standardized mortality rates (SMRs). RESULTS: Among 69 701 incident dialysis patients, 9.1% with PRD diabetes underwent LLA within 3 years, versus 2.6% with diabetes as comorbidity and 0.6% without diabetes. Risk factors for LLA included diabetes [subdistribution hazard ratio (sHR) 9.3 for PRD diabetes, sHR 3.6 for diabetes as comorbidity], peripheral vascular disease (sHR 2.11), prior amputation (sHR 2.19), ischaemic heart disease and White ethnicity. Major amputation rates declined over time, while minor amputation rates remained stable. Significant inter-centre variation was observed after adjustment. One-year mortality after LLA exceeded 40% in all subgroups. SMRs were highest in the PRD diabetes group compared with the general population (34.7), but highest in the diabetes as comorbidity group compared with the dialysis population (5.31). CONCLUSION: Incident dialysis patients, particularly those with PRD diabetes, face high LLA risk and very poor survival after amputation. Persistent inter-centre variation suggests scope for national audit, standardized foot care and preventive strategies.
Rituximab-based therapy in infection-associated severe crescentic proliferative glomerulonephritis with monoclonal immunoglobulin deposition.
Richiez P, Clapp WL, Shah CV
Clin Kidney J · 2026 Apr · PMID 42038162 · Full text
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Green CKD care: 10 tips to make nephrology outpatient clinics more environmentally sustainable.
Berman-Parks N, Rho E, Stoneman S … +2 more , Woywodt A, Torreggiani M
Clin Kidney J · 2026 Apr · PMID 42038161 · Full text
Green nephrology has often focussed on dialysis, with its intensive use of water and energy. In comparison, non-dialysis outpatient care of chronic kidney disease (CKD) has received less attention. This is surprising, gi...
Green nephrology has often focussed on dialysis, with its intensive use of water and energy. In comparison, non-dialysis outpatient care of chronic kidney disease (CKD) has received less attention. This is surprising, given how much time most of us spend in outpatient clinics. For most of us, this is where we not only see the majority of our patients but also have regular encounters with their relatives and loved ones. Non-dialysis outpatient clinics are therefore an important opportunity to start a dialogue on green nephrology with our patients and with the general public. It is also where we can act as role models for the next generation of nephrologists and where it is easier to talk about green nephrology than in a busy inpatient setting or ward environment. Excellent and modern CKD care is in itself highly effective in reducing the environmental footprint of nephrology, where it delays progression, facilitates early and pre-emptive transplantation and avoids dialysis. CKD medication also has an environmental footprint, which can be addressed through medication reviews and fixed combinations. Innovative provision of care, e.g. through video consultations, needs to consider how patients will access medication in this scenario. Recycling and avoiding waste are also very important, although in practice they face many challenges. Reducing paper use is another option to improve sustainability, but transition to paper-free outpatient care takes time and effort. Simple steps can be taken to reduce paper use where clinic letters are still paper based. Video consultations are increasingly used where safe and appropriate and reduce the environmental footprint of care. Artificial intelligence will, in the near future, help us to triage new and existing patients and prioritize scarce resources and face-to-face care on those at highest risk. Outpatient clinics, although busy, offer an opportunity to interact with colleagues, patients and relatives to educate about green nephrology.
Breath ammonia test for chronic kidney disease screening: impact of fasting on diagnostic accuracy.
Chan MJ, Liau SK, Li YJ … +5 more , Zan HW, Meng HF, Lai CS, Su YJ, Tian YC
Clin Kidney J · 2026 Apr · PMID 42027901 · Full text
BACKGROUND: Chronic kidney disease (CKD) is a global health concern and early detection is crucial for preventing progression. Current screening methods are inconvenient and resource intensive. Breath ammonia has been pr...
BACKGROUND: Chronic kidney disease (CKD) is a global health concern and early detection is crucial for preventing progression. Current screening methods are inconvenient and resource intensive. Breath ammonia has been proposed as a non-invasive biomarker for renal dysfunction but its diagnostic accuracy and the impact of fasting remain unclear. This study aimed to validate the breath ammonia test for CKD screening and assess the effect of fasting on its diagnostic performance. METHODS: This prospective study included 244 participants: a derivation cohort ( = 121) and a validation cohort ( = 123). Breath ammonia was measured using a vertical-channel organic semiconductor sensor. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease equation. Receiver operating characteristics (ROC) curve analysis was used to evaluate diagnostic performance, and fasting was defined as ≥4 hours without intake. RESULTS: The average age of the participants was 60.7 years, with males comprising 51% of the cohort. Breath ammonia levels significantly correlated with serum creatinine ( = 0.695, < .001), eGFR ( = -0.533, < .001) and blood urea nitrogen ( = 0.765, < .001). Using a cut-off of 886 ppb, breath ammonia predicted eGFR <60 ml/min/1.73 m with a sensitivity of 78.5% and a specificity of 81.6% (area under the ROC = 0.842). Fasting enhanced diagnostic accuracy, improving sensitivity and specificity to 87.9% and 91.5%, respectively (area under the ROC = 0.939). Conversely, non-fasting patients demonstrated lower sensitivity and specificity at 74.5% and 74.6%, respectively. CONCLUSIONS: The breath ammonia test is a promising non-invasive CKD screening tool. Standardizing pretest fasting may further improve its diagnostic accuracy.
Top ten tips to manage patients after acute kidney injury.
Selby NM, De Seigneux S, Saritas T … +6 more , Cantaluppi V, Sanz AB, Faguer S, Lopes JA, Ostermann M, Gameiro J
Clin Kidney J · 2026 Apr · PMID 42027900 · Full text
Despite high mortality, most patients who experience an episode of acute kidney injury (AKI) survive to hospital discharge. These patients are at increased risk for chronic kidney disease (CKD), recurrent AKI, cardiovasc...
Despite high mortality, most patients who experience an episode of acute kidney injury (AKI) survive to hospital discharge. These patients are at increased risk for chronic kidney disease (CKD), recurrent AKI, cardiovascular events, hospital readmission, and premature mortality. AKI is causally linked to some of these longer-term outcomes, particularly CKD, but non-causal associations also serve to identify vulnerable patients at higher risk. In both scenarios, there is a role for improved post-discharge AKI care. However, current evidence for how to deliver this is incomplete, and there are knowledge gaps around which interventions are effective, which patients may benefit the most, and the health-economic impact of new care pathways. Current guidelines recommend monitoring kidney function within 3 months of AKI for all patients, which is challenging to implement and fails to account for varying individual patient needs. In this review, we suggest 'top ten tips' that underpin a pragmatic framework for post-AKI care, based on the best available evidence. With a central role for patient engagement and education, these include early follow-up for patients with incomplete renal recovery, structured assessment of kidney function (including urinary albumin: creatinine ratio, and where appropriate, cystatin C), guideline-directed medication optimization (in particular renin-angiotensin-aldosterone-system inhibitors and sodium-glucose co-transporter 2 inhibitors), cardiovascular risk management and consideration of biopsychosocial aspects of recovery. These are supported by clear and actionable discharge communication, and coordination with other specialities and primary care.
Targeting HIF2-PTHrP axis in kidney cancer: a paradigm shift in therapy?
Pella E, Jose Soler M
Clin Kidney J · 2026 Apr · PMID 42027899 · Full text
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Accurate prediction of intradialytic hypo- and hypertension in haemodialysis patients: the dual-attention Transformer model.
Guan X, Chen P, Li Y … +7 more , Liu H, Ye Z, Zhang G, Chen Y, Han L, Hu Z, Peng H
Clin Kidney J · 2026 Apr · PMID 42027898 · Full text
BACKGROUND: Intradialytic hypotension (IDH) and intradialytic hypertension (IDHTN) are frequent haemodialysis complications, each independently linked to increased cardiovascular risk and all-cause mortality. Existing pr...
BACKGROUND: Intradialytic hypotension (IDH) and intradialytic hypertension (IDHTN) are frequent haemodialysis complications, each independently linked to increased cardiovascular risk and all-cause mortality. Existing predictive models often fail to capture the irregular nature of real-world haemodialysis data. The study objective was to develop an advanced machine learning architecture specifically designed for irregular time-series analysis of dialysis. METHODS: We conducted a retrospective analysis of 1300 haemodialysis patients, encompassing 182 111 sessions and 1 201 323 timestamped observations. Patients were randomly assigned to training (80%), validation (10%) and testing (10%) cohorts. IDH and IDHTN were defined by systolic blood pressure (BP) changes from pre-dialysis baseline: IDH is defined as a systolic BP <90 mmHg, and IDHTN is defined as an increase of ≥10 mmHg in systolic BP without the occurrence of IDH. A Transformer model with dual-attention mechanism was developed for real-time event prediction. Performance was evaluated using area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC) and F1 score. RESULTS: In the whole cohort, the incidence of IDH and IDHTN was 0.79% and 25.60%, respectively. The Transformer model demonstrated robust predictive accuracy in the test cohort, achieving AUROCs of 0.96 for IDH and 0.88 for IDHTN (all < .01). The model's high AUPRCs for both definitions confirmed its sensitivity in detecting early or moderate BP fluctuations. To assess clinical utility, a complementary LightGBM model using pre-dialysis features predicted common symptoms or interventions with an accuracy of 0.926. Feature importance analyses validated established risk factors and identified key time-dependent covariates. CONCLUSION: Our dual-attention Transformer model enables accurate, real-time prediction of intradialytic BP abnormalities by effectively interpreting complex, asynchronous clinical data.
Neutral impact of mTOR inhibitors on cardiovascular outcomes after kidney transplantation.
Domingo-Pinent E, Cacho J, Cassia M … +17 more , Torres V, Vergara H, Herceda A, Juarez P, Gonzalez-Rojas Á, Rodríguez-Espinosa D, Montagud-Marrahi E, Arana C, Molina-Andujar A, Ventura-Aguiar P, Esforzado N, Revuelta I, Torregrosa JV, Oppenheimer F, Francino A, Diekmann F, Cucchiari D
Clin Kidney J · 2026 Apr · PMID 42027897 · Full text
BACKGROUND: In kidney transplantation, it remains unclear whether mammalian target of rapamycin inhibitors (mTORi) improve cardiovascular outcomes-through plaque stabilization and attenuation of left ventricular remodeli...
BACKGROUND: In kidney transplantation, it remains unclear whether mammalian target of rapamycin inhibitors (mTORi) improve cardiovascular outcomes-through plaque stabilization and attenuation of left ventricular remodeling-or worsen them by deranging glucose and lipid metabolism. We aimed to assess the true impact of this drug class on major cardiovascular outcomes in a deeply phenotyped cohort with long-term follow-up. MATERIALS AND METHODS: All patients transplanted at our center between 1st June 2013 and 31st December 2019 ( = 845) were screened for inclusion. A total of 492 patients were selected through 1:1 propensity score matching (PSM) based on 18 key donor and recipient variables. All patients received tacrolimus (TAC), steroids, and either mTORi ( = 246) or mycophenolic acid (MPA) ( = 246). The primary outcome was major adverse cardiovascular events (MACE), defined as non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death. RESULTS: Baseline variables were adequately balanced after PSM (absolute standardized difference <0.10). Over a mean follow-up of 4.81 ± 2.49 years, MACE occurred in 78 patients (15.9%), with no significant difference between the mTORi and MPA groups (HR[95% CI] 0.84[0.54-1.30], = 0.443). Subgroup analyses-including patients with diabetes, prior MACE, stable immunosuppression, or pre-transplant ischemia testing-also showed no differences. Independent predictors of MACE were age (HR[95% CI] for upper tertile 2.17[1.38-3.42], < 0.001), dialysis vintage (HR[95% CI] for upper tertile 1.91[1.22-3.01], = 0.005), prior myocardial infarction (HR[95% CI] 2.12[1.19-3.78], = 0.011), and deceased vs. living donor graft (HR[95% CI] 3.42[1.47-7.92], = 0.004). CONCLUSIONS: Cardiovascular disease after kidney transplantation occurs due to non-modifiable risk factors and does not appear to be related to baseline immunosuppression.
Continuous monitoring of relative blood volume allows real-time assessment of intradialytic hypotension risk.
Aniort J, Bachelet T, Seris P … +9 more , Dolley-Hitze T, Bouiller M, Beji C, Batel V, Pereira B, Attaf D, Kopperschmidt P, Heng AE, Canaud B
Clin Kidney J · 2026 Apr · PMID 42027896 · Full text
BACKGROUND: Intradialytic hypotension (IDH) is a frequent complication of hemodialysis, associated with patient discomfort, end-organ injury, and higher mortality. Prediction remains challenging. The value of relative bl...
BACKGROUND: Intradialytic hypotension (IDH) is a frequent complication of hemodialysis, associated with patient discomfort, end-organ injury, and higher mortality. Prediction remains challenging. The value of relative blood volume (RBV) monitoring is debated. We investigated whether RBV indicates IDH risk and enables real-time prediction. METHODS: In this prospective, multicenter study, 56 patients across 459 hemodialysis sessions were monitored with RBV sensors. IDH was defined as a systolic blood pressure <90 mmHg with a ≥20 mmHg decrease from baseline. RBV trajectories were analyzed using unsupervised clustering to identify risk patterns, and a time-varying RBV threshold was derived. Associations with IDH were tested using generalized linear mixed models (GLMMs) with patient as random effects. Predictive performance was evaluated using GLMMs and benchmarked against XGBoost, with validation performed session wise and patient wise. RESULTS: IDH occurred in 29.7% of sessions and was associated with RBV decline. At the time of measurement, each 1% decrease in RBV increased IDH risk (OR = 1.05; < .001). Falling below the dynamic RBV threshold doubled the odds of IDH (OR = 2.37; < .001). In predictive analysis assessing IDH occurrence within the subsequent 10-60 minutes, GLMMs showed good discrimination in session-wise validation (AUC = 0.77) but were less accurate in patient-wise validation (AUC = 0.62). Incorporating patient-specific features improved patient-wise performance (AUC = 0.85 for GLMM; 0.86 for XGBoost). CONCLUSIONS: RBV decline is a robust predictor of IDH. Including RBV in real-time risk models may help personalize ultrafiltration strategies and improve dialysis safety.
Assessing kidney fibrosis via multiparametric MRI in native kidney and allografts.
Berchtold L, Huber A, Aslam I … +6 more , Crowe LA, Brito W, de Perrot T, de Seigneux S, Pruijm M, Vallée JP
Clin Kidney J · 2026 Apr · PMID 42027895 · Full text
BACKGROUND: Renal interstitial fibrosis is a well-established prognostic indicator for kidney health, typically assessed via invasive biopsy. Diffusion-weighted magnetic resonance imaging (MRI) provides a non-invasive al...
BACKGROUND: Renal interstitial fibrosis is a well-established prognostic indicator for kidney health, typically assessed via invasive biopsy. Diffusion-weighted magnetic resonance imaging (MRI) provides a non-invasive alternative by measuring the cortico-medullary difference in apparent diffusion coefficient (ΔADC), an inverse correlation with fibrosis has been reported in monocentric studies. This study evaluates the reproducibility of ΔADC across two centres and validates its diagnostic performance in native and allograft kidneys. The performance of T1 and T2 mapping is also assessed. METHODS: In this prospective cohort study, patients with chronic kidney disease (CKD) and kidney allograft recipients from two hospitals underwent renal biopsy and MRI within 1 week. Correlations between ΔADC, T1 and T2 mapping, and histological fibrosis were assessed in the overall cohort and subgroups based on kidney type and biopsy indication. Receiver operating characteristic (ROC) analysis evaluated the performance of ΔADC for low and high fibrosis. Additional analyses examined correlation between MRI parameters, eGFR, and histological inflammation. A multivariable logistic regression identified predictors of high fibrosis. RESULTS: Among 337 patients (121 CKD, 216 allografts), ΔADC correlated negatively with fibrosis ( = -0.42), consistently across centres and kidney type (native = -0.49; allograft = -0.39) and regardless of biopsy indication; T1 correlated only in native kidneys with fibrosis, whereas T2 correlated with degree of inflammation in biopsies with low fibrosis. ΔADC showed the best diagnostic accuracy for low (<25%) and high (>50%) fibrosis {AUCs 0.71 [CI95% (0.66;0.77)] and 0.83 [CI95% (0.76;0.91)]; cut-offs 41.5 and -32 × 10 mm²/s, respectively}. ΔADC, eGFR, proteinuria, and diabetes independently predicted high fibrosis {model AUC = 0.95 [CI95% (0.90; 0.99)]}. CONCLUSION: ΔADC reliably reflects renal fibrosis across two independent centres and kidney type, supporting diffusion MRI as a non-invasive tool for fibrosis assessment.
Fracture risk after kidney transplantation: unchanged and unaddressed: a registry-based cohort study across two decades.
Ystrøm IK, Christiansen CF, Ivarsen P … +3 more , Evenepoel P, Hansen D, Jørgensen HS
Clin Kidney J · 2026 Mar · PMID 42022277 · Full text
BACKGROUND: Kidney transplant recipients face a high risk of adverse events, including fractures. Reported fracture rates post-transplant vary widely and may have changed over time. The consequences of a fracture, especi...
BACKGROUND: Kidney transplant recipients face a high risk of adverse events, including fractures. Reported fracture rates post-transplant vary widely and may have changed over time. The consequences of a fracture, especially subsequent fractures, remain under-investigated. This study examined the risk and prognosis of fractures after kidney transplantation in the current era. METHODS: This retrospective cohort study included all adults who received a first single-organ kidney transplant between 2000 and 2022 in Denmark. Nationwide healthcare registries were utilized to identify the study population and provide demographic data, diagnostic and procedural codes, and prescription data. Cumulative incidence (risk) of both first fracture and subsequent fracture was computed, treating death as a competing risk. Crude, and sex- and age-standardized incidence rates were estimated for different time periods. RESULTS: The study included 3977 first kidney transplant recipients, of whom 788 sustained any post-transplant fracture. The 10-year risk of fracture was 21% (95% confidence interval 20-23). Crude incidence rates of any fracture remained unchanged over time, while standardized estimates showed a slight decline. Fractures were primarily located at the peripheral skeleton. Twenty-eight percent of patients with a fracture sustained a subsequent fracture, with the highest incidence at 6-12 months following the first event. CONCLUSIONS: Kidney transplant recipients remain at high fracture risk, with unchanged fracture rates over the past 20 years. The imminent fracture risk following a first fracture is high and largely unaddressed. Although formal guidelines have yet to be established, this knowledge should urge clinicians to perform risk assessment and consider intervention following a post-transplant fracture.
Protocadherin FAT1-associated membranous nephropathy after hematopoietic stem cell transplantation-a cohort study with clinico-pathological correlations.
Nackenhorst MC, Milovanovic D, Schmidt A … +5 more , Mongera N, Köller M, Passler W, Cejka D, Kozakowski N
Clin Kidney J · 2026 Mar · PMID 42022276 · Full text
BACKGROUND: The identification of causative antigens for membranous nephropathy (MN) has revolutionized the comprehension of the pathophysiology of this autoimmune disease and its management. Recently, some studies descr...
BACKGROUND: The identification of causative antigens for membranous nephropathy (MN) has revolutionized the comprehension of the pathophysiology of this autoimmune disease and its management. Recently, some studies described protocadherin FAT1 (FAT1) as a causal antigen in the context of hematopoietic stem cell transplantation (HSCT). The aim of this study was to investigate the large Viennese kidney biopsy collection at the Department of Pathology of the Medical University of Vienna and explore MN cases after HSCT for the causative antigen. METHODS: Fifteen patients were identified with MN in diagnostic renal biopsies for proteinuria/nephrotic syndrome after HSCT between 2001 and 2024. Cases were reviewed and tested for the expression of FAT1 by immunofluorescence specifically. RESULTS: Immunofluorescence showed that 12 out of 15 patients with MN had FAT1 expression, appearing 2.3 years after HSCT. In three patients without FAT1 expression, MN appeared 3.8 years after HSCT, with one testing positive for phospholipase A2 receptor (PLA2R) and two with unknown antigens. Serum creatinine for FAT1+ MN was 1.2 mg/dl, while FAT1- MN was 1.3 mg/dl. Proteinuria was 8 g/g compared to 10.4 g/g, respectively. IgG4 positivity was seen in 30% of FAT1+ MN cases. Over a follow up of 5.2 years, of the seven FAT1+ MN patients treated with rituximab, four achieved complete remission, two partial remission, and one was non-responsive. CONCLUSION: This hitherto largest single-center-cohort solidifies FAT1 as a causative antigen for MN in the setting of HSCT. However, not all post-HSCT-MN are related to FAT1.
Impaired humoral and cellular immune responses to recombinant zoster vaccine in kidney transplant recipients treated with belatacept.
de Nattes T, Van Wynsberghe M, Lemée V … +3 more , Hanoy M, Candon S, Bertrand D
Clin Kidney J · 2026 Apr · PMID 42017033 · Full text
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Lenvatinib-associated hyaline occlusive glomerular microangiopathy.
Daher A, Kenig-Kozlovsky Y, Tchirkov M … +3 more , Milo G, Ben-Itzhak O, Assady S
Clin Kidney J · 2026 Apr · PMID 42017032 · Full text
Nephrologists play a key role in managing renal complications related to malignancy and its treatment. Although immunotherapies and oral small-molecule agents have revolutionized cancer care, severe adverse events may li...
Nephrologists play a key role in managing renal complications related to malignancy and its treatment. Although immunotherapies and oral small-molecule agents have revolutionized cancer care, severe adverse events may limit their use. We report a distinctive glomerular injury pattern associated with lenvatinib, an oral receptor tyrosine kinase inhibitor. Similar histopathologic features have been observed with bevacizumab and antivascular endothelial growth factor receptor 2 (VEGFR2) antibodies. This case includes extended clinical follow-up, kidney biopsy findings, and therapeutic modification, suggesting a possible association between VEGF-VEGFR2 pathway inhibition and reversible nephrotoxicity.
Poor compliance of recurrent stone formers to increase their fluid intake in spite of repeated recommendation.
Bankir L, Daudon M
Clin Kidney J · 2026 Apr · PMID 42017031 · Full text
BACKGROUND: The aim of this study was to evaluate 24-h urine volume (UV), estimated osmolarity (eU), and Tiselius APCaOx index (TIS) in 181 calcium oxalate stone formers, and the changes achieved in response to the recom...
BACKGROUND: The aim of this study was to evaluate 24-h urine volume (UV), estimated osmolarity (eU), and Tiselius APCaOx index (TIS) in 181 calcium oxalate stone formers, and the changes achieved in response to the recommendation to reach a UV of at least 2 l per day, during a follow-up of at least 3 years. METHODS: Patients of each sex were divided into recurrent (R) and non-recurrent (NR) stone formers according to stone events during follow-up. UV, eU, and TIS were evaluated at baseline (BSL) and End (END). TIS was also determined in first morning urine. Results were compared by two-way ANOVA or chi square. RESULTS: Mean follow-up was 6.8 years. The 24-h osmolar excretion did not differ between R and NR in either sex, and remained stable between BSL and END. UV was significantly lower in R than NR, both at BSL and END, and eU was 100-150 mosm/kg HO higher in R. In both sexes, the increase in UV observed between BSL and END was significantly smaller in R than NR. TIS values were significantly higher in R than NR. They were higher at END than at BSL only in R patients, suggesting a poor compliance of R to drink more. The threshold of TIS for a high risk of crystalluria was found to be 2.45 in both men and women. CONCLUSION: In conclusion, the patients who showed recurrence of lithiasis not only had lower baseline UV, but were also less able to increase UV than those who did not recur, in spite of recommendations to drink more. Based on preliminary information in the literature, a clinical trial could be designed to evaluate, in these patients, if a low dose of a selective V2 receptor antagonist, increasing their diuresis (and thirst), would prevent new stones.
Elevated leucine-rich alpha-2 glycoprotein levels and mortality risk in end-stage renal disease: evidence for gender differences.
Xiong J, Li X, Liu Y … +7 more , Hocher JG, Reichetzeder C, Elitok S, Horvathova K, Krämer BK, Tepel M, Hocher B
Clin Kidney J · 2026 Apr · PMID 42017030 · Full text
BACKGROUND: Leucine-rich α-2 glycoprotein (LRG) is an inflammation-related serum protein implicated in cardiovascular pathology. Its prognostic role in patients with end-stage renal disease (ESRD) remains unclear. We inv...
BACKGROUND: Leucine-rich α-2 glycoprotein (LRG) is an inflammation-related serum protein implicated in cardiovascular pathology. Its prognostic role in patients with end-stage renal disease (ESRD) remains unclear. We investigated the association between serum LRG levels and all-cause mortality in maintenance haemodialysis patients, with a focus on sex-specific effects. METHODS: In this prospective cohort study, 313 stable haemodialysis patients (206 males, 107 females) were enrolled and followed for 5 years. Baseline serum LRG concentrations were quantified by ELISA. Receiver operating characteristic (ROC) analysis identified an optimal mortality risk cut-off (45.5 µg/ml). Survival analyses used Kaplan-Meier curves and multivariable Cox regression models adjusted for demographic, clinical, and laboratory covariates. Analyses were stratified by sex. RESULTS: During follow-up, 103 deaths occurred (78 males, 25 females). Higher LRG levels were significantly associated with increased mortality risk in males (log-rank < .001), but not females ( = .17). In adjusted Cox models, male patients with LRG >45.5 µg/ml had a ∼2-fold higher mortality risk [hazard ratio (HR) = 2.07; 95% confidence interval (CI) 1.32-3.23] compared to those below the cut-off. The association remained robust after further adjustment for C-reactive protein, albumin, dialysis vintage, and comorbidities. No significant association was observed in females (HR = 1.24; 95% CI = 0.65-2.34). ROC analysis yielded an AUC of 0.604 for LRG in predicting mortality. CONCLUSIONS: Elevated serum LRG independently predicts all-cause mortality in male, but not female, haemodialysis patients. These findings highlight the potential of LRG as a sex-specific biomarker for risk stratification in ESRD and underscore the need for mechanistic studies on sex differences in LRG-related pathways.
Evolving kidney disease phenotypes in type 2 diabetes: declining albuminuria and increasing isolated low eGFR.
De Cosmo SA, Russo G, Nicolucci A … +12 more , Rossi C, Graziano G, Fioretto P, Tuccinardi D, Viazzi F, Sartore G, Muscarà A, Cuttone A, Piscitelli P, Candido R, Di Cianni G, Pontremoli R
Clin Kidney J · 2026 Apr · PMID 42017029 · Full text
BACKGROUND: This study investigated the prevalence and clinical correlates of renal phenotypes in two cohorts of type 2 diabetes (T2D) patients, assessed temporal trends, and evaluated associations with treatment regimen...
BACKGROUND: This study investigated the prevalence and clinical correlates of renal phenotypes in two cohorts of type 2 diabetes (T2D) patients, assessed temporal trends, and evaluated associations with treatment regimens. These figures were compared to those previously recorded in a similar, real world cohort 15 years earlier in Italy. METHODS: Clinical data from 378 914 T2D patients attending the AMD network in 2023 in Italy were retrieved and compared to a similar cohort of prevalent patients in 2009. Renal phenotypes were classified as isolated albuminuria, isolated reduced eGFR (<60 ml/min/1.73 m²), or both. Multivariate logistic regression identified factors associated with these phenotypes. RESULTS: In the 2023 study cohort, 51.3% of patients showed preserved renal function, 17.9% had isolated low eGFR, 17.4% had isolated albuminuria, and 13.3% exhibited both conditions. Female gender was independently associated with isolated low eGFR (OR = 1.28), whereas male gender was linked to albuminuria. Age was significantly related to both renal abnormalities, while longer diabetes duration increased the likelihood of low eGFR. CONCLUSIONS: Compared with the 2009 cohort, the prevalence of CKD in T2D remains stable in 2023, with albuminuric phenotypes decreasing and isolated low eGFR phenotypes increasing. These trends may reflect the aging population and evolving treatment practices, including a growing use of nephroprotective agents such as RAS inhibitors, SGLT2 inhibitors, and GLP-1 receptor agonists as well as better control of blood pressure. Longitudinal studies are needed to address changing clinical scenarios.
The role of sleep disorders in the risk for CKD and CKD progression.
Zoccali C, Mallamaci F, Kanbay M … +2 more , Grassi G, Mancia G
Clin Kidney J · 2026 Apr · PMID 42017028 · Full text
Chronic kidney disease (CKD) is a major global health problem and an important driver of cardiovascular morbidity and mortality. Sleep disorders are highly prevalent in people with, or at risk of, CKD, but their specific...
Chronic kidney disease (CKD) is a major global health problem and an important driver of cardiovascular morbidity and mortality. Sleep disorders are highly prevalent in people with, or at risk of, CKD, but their specific contribution to CKD onset and progression has not been clearly defined. Unlike previous reviews that have focused mainly on symptom burden, quality of life, or general management of sleep problems in CKD, this narrative review is explicitly centred on renal outcomes. We examine whether common sleep disorders-insomnia, abnormal sleep duration, restless legs syndrome, periodic limb movement disorder, and obstructive sleep apnoea (OSA) and central sleep apnoea-are associated with an increased risk of incident CKD and with faster progression of established CKD [estimated glomerular filtration rate (eGFR) decline, albuminuria, end-stage kidney disease]. We synthesize evidence from prospective cohorts, administrative databases, and Mendelian randomization studies, with particular attention to residual confounding, incomplete sleep phenotyping, and overlap between sleep disorders, especially unrecognized OSA. Observational data suggest that poor sleep quality and abnormal sleep duration are modestly associated with incident CKD and CKD progression, although independence from OSA remains uncertain. In contrast, evidence linking OSA to reduced eGFR, albuminuria, and accelerated CKD progression is more consistent, and bidirectional relations between CKD and OSA are increasingly recognized. We also review pathophysiological pathways that plausibly connect sleep disorders to renal injury and critically appraise preliminary interventional data on OSA treatment and kidney outcomes. Finally, we outline the clinical implications of integrating outcome-oriented sleep assessment into nephrology and hypertension care and propose a research agenda to determine whether systematic detection and treatment of sleep disorders, particularly OSA, should be adopted as a strategy to prevent CKD onset and slow CKD progression.
Clinical outcomes of glucagon-like peptide-1 receptor agonist therapy in kidney transplant recipients: a systematic review and meta-analysis.
Kanbay M, Abdel-Rahman SM, Guldan M … +5 more , Ozbek L, Genc NI, Ak AB, Covic A, Goren HK
Clin Kidney J · 2026 Apr · PMID 42017027 · Full text
BACKGROUND: Metabolic complications after kidney transplantation (KT) significantly affect graft and patient survival. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) offer cardio-renal benefits in the general popul...
BACKGROUND: Metabolic complications after kidney transplantation (KT) significantly affect graft and patient survival. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) offer cardio-renal benefits in the general population, but evidence in KT recipients remains limited. METHODS: We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines (PROSPERO: CRD420251153352). PubMed, Scopus, Web of Science, Ovid MEDLINE, and Cochrane Library were searched up to September 2025 for studies evaluating GLP-1RA therapy in adult KT recipients. Random-effects models pooled outcomes for metabolic, renal, cardiovascular, and safety endpoints. RESULTS: Seventeen studies ( = 54 680 KT recipients) were included. GLP-1RAs use significantly reduced all-cause mortality (HR 0.53, 95% CI 0.36-0.79, = 4) and major adverse cardiovascular events (OR 0.55, 95% CI 0.47-0.66, = 3). Estimated glomerular filtration rate (eGFR) remained stable at 3 months, improved at 6 months (+1.99 ml/min/1.73 m², 95% CI 0.52-3.47, = 5) and 12 months (+2.24 ml/min/1.73 m², 95% CI 0.02-4.46, = 6), and was preserved at 24 months. GLP-1RAs lowered HbA1c (MD -0.54%, 95% CI -0.89 to -0.19, = 13) and body mass index (SMD -0.32, 95% CI -0.49 to -0.15, = 12) from baseline, with parallel reductions in insulin requirement and urinary albumin excretion. Tacrolimus levels were unaffected at 6 months and modestly decreased at 1 year without compromising graft function. Adverse events were mainly mild gastrointestinal intolerance (10%-20%), with rare discontinuations and no increased risk of hypoglycemia, pancreatitis, or infections. CONCLUSION: GLP-1RAs are associated with improved glycemic control, weight, and cardiovascular outcomes, with no consistent signal of adverse effects on graft stability and immunosuppressive balance. GLP-1RA integration into individualized post-transplant care may be considered for patients with diabetes or metabolic syndrome, with close clinical monitoring.
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