Poyan Mehr A, Sundang A, Drasin T
… +3 more, Bhalla N, Zheng S, Pravoverov L
Clin Kidney J
· 2026 Apr · PMID 41929582
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BACKGROUND: Peritoneal dialysis (PD) is an increasingly emphasized modality in nephrology care, due to patient autonomy, reduced healthcare cost and alignment with value-based care initiatives. A critical factor influenc...BACKGROUND: Peritoneal dialysis (PD) is an increasingly emphasized modality in nephrology care, due to patient autonomy, reduced healthcare cost and alignment with value-based care initiatives. A critical factor influencing successful PD uptake is the timely placement of peritoneal dialysis catheters (PDCs). Traditional advanced laparoscopic surgical (ALS) methods are effective but constrained by the need for general anesthesia and operating room access. The image-guided percutaneous (IGP) approach has emerged as a potentially safer and more accessible alternative. METHODS: We conducted a retrospective study of adult patients who underwent PDC placement within Kaiser Permanente Northern California (KPNC) from 1 January 2018 to 31 December 2022. Patient characteristics, procedural variables, post-procedure length of stay, 90- and 180-day catheter intervention rates, 30-day readmission and mortality rates were compared between IGP and ALS techniques. RESULTS: Among 3062 patients, 835 (27%) received PDCs via IGP and 2227 (73%) via ALS. While there were differences in patient characteristics due to selection biases, with the IGP group having higher prevalence of heart failure, and lower body mass index (BMI), estimated glomerular filtration rate, hemoglobin and albumin levels, IGP was associated with significantly shorter post-procedure length of stay among admitted outpatients (1.8 vs 3.1 days, = .01) and lower catheter intervention rates at 90 days (1% vs 2.5%, = .006) and 180 days (1.3% vs 4%, < .0001). After adjustment for patient gender, race, BMI and polycystic kidney disease status, the ALS technique remained significantly associated with higher odds of catheter re-intervention compared with IGP at both 90 days [adjusted odds ratio (OR) 2.76, 95% confidence interval (CI) 1.30-5.85, = .008] and 180 days (adjusted OR 3.16, 95% CI 1.67-5.96, < .0004). Overweight BMI was independently associated with increased intervention risk. CONCLUSIONS: Despite being applied to a potentially sicker patient cohort, IGP was associated with favorable short- and intermediate-term outcomes compared with ALS, including reduced catheter interventions, without compromising safety outcomes.
Kraus D, Gieswinkel A, Boedecker-Lips SC
… +13 more, Klimpke P, Stortz M, Schleicher EM, Schattenberg JM, Pfeiffer N, Ghaemi J, Schmidtmann I, Lackner KJ, Tüscher O, Münzel T, Wild PS, Galle PR, Weinmann-Menke J
Clin Kidney J
· 2026 Feb · PMID 41890981
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BACKGROUND: Early diagnosis of chronic kidney disease (CKD) is essential to slow progression and delay or prevent dialysis. However, in the absence of specific symptoms, patients and physicians may remain unaware of the...BACKGROUND: Early diagnosis of chronic kidney disease (CKD) is essential to slow progression and delay or prevent dialysis. However, in the absence of specific symptoms, patients and physicians may remain unaware of the disease for a long period. Here we present an analysis from the Gutenberg Health Study, a prospective longitudinal cohort study, to estimate the prevalence of CKD indicators in the population. METHODS: A representative sample of 10 125 individuals underwent extensive medical testing at baseline; 9331 were tested again after 5 years. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula with serum creatinine. Urinary albumin:creatinine ratios (UACRs) were determined from spot urine samples. RESULTS: At baseline, 2.5% of subjects had decreased eGFR (<60 ml/min/1.73 m), 10.4% had increased albuminuria (UACR >30 mg/g) and 1.0% had both. Within 5 years, the incidence of new-onset decreased eGFR was 3.4%, the incidence of new-onset increased albuminuria was 6.9% and 1.4% had both new-onset decreased eGFR and increased albuminuria. Most importantly, 6.8% of all subjects and 3.2% of subjects without hypertension, diabetes or known kidney disease had chronic increased albuminuria, consistent with the presence of CKD. CONCLUSIONS: This is the first study to report the longitudinal prevalence of CKD in the population. Chronic increased albuminuria, a sensitive marker of CKD, is highly prevalent in the German population even in the absence of risk factors for kidney disease.
Yao Y, Ma Y, Jin Y
… +10 more, Wang M, Ni C, Shang S, Xing C, Zhang Z, Xie K, Liu J, Wang L, Liu S, Gao J
Clin Kidney J
· 2026 Mar · PMID 41890914
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Radiomics is a promising quantitative imaging technique that extracts and analyzes high-throughput features from medical images, providing detailed structural and functional information. It has gained significant attenti...Radiomics is a promising quantitative imaging technique that extracts and analyzes high-throughput features from medical images, providing detailed structural and functional information. It has gained significant attention in diabetic kidney disease (DKD) research, particularly in assessing renal fibrosis and predicting treatment outcomes. Radiomics offers a novel approach for accurate DKD diagnosis and holds potential for personalized treatment strategies. When combined with artificial intelligence and machine learning, it can create predictive models that improve clinical decision-making. Integrating radiomics with genomics and metabolomics further enhances understanding of disease mechanisms and facilitates biomarker discovery. Despite its potential, challenges such as lack of standardization, complex feature selection, limited model interpretability and inadequate clinical validation remain. Future advancements in imaging technologies, more efficient algorithms and large-scale clinical studies are expected to establish radiomics as a critical tool in precision medicine for DKD, enabling more accurate and personalized non-invasive diagnostics and therapies in nephrology.
Xie S, Guessous I, Golshayan D
… +3 more, Thomas A, Vaucher J, Marques-Vidal P
Clin Kidney J
· 2025 Sep · PMID 41890552
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BACKGROUND: Recent evidence suggests that magnesium deficiency may play a role in the development and progression of chronic kidney disease (CKD). We assessed the association between genetic variations, serum magnesium l...BACKGROUND: Recent evidence suggests that magnesium deficiency may play a role in the development and progression of chronic kidney disease (CKD). We assessed the association between genetic variations, serum magnesium levels and CKD risk in the general population. METHODS: In this population-based prospective study ( = 4047; mean age 53 years; 54% female; mean follow-up 12.5 years), Cox regression models evaluated the effects of hypomagnesemia on CKD risk. Genetic risk scores and mediation analyses were used to assess the direct and indirect effects of single-nucleotide polymorphisms (SNPs) on CKD development through magnesium levels. One-sample and two-sample Mendelian randomization (MR) analyses were conducted to examine the causal relationship between genetically predicted serum magnesium levels and CKD risk. RESULTS: Multivariable Cox regression analyses identified that hypomagnesemia was significantly associated with an increased risk of CKD, with a hazard ratio of 1.73 (95% confidence interval 1.14-2.61, = .010). Analyses based on single SNPs and SNP scores did not reveal direct effects on CKD risk. Mediation analyses demonstrated that four SNPs exerted significant indirect effects on CKD risk through serum magnesium levels. However, the proportion of the total effect mediated by magnesium was low and not statistically significant. MR analyses did not provide strong evidence for a significant causal relationship between genetically predicted magnesium levels and CKD risk. CONCLUSIONS: Hypomagnesemia was significantly associated with an increased risk of long-term CKD. Genetic analysis suggests that serum magnesium levels may play an indirect role in CKD risk, but no clear causal relationship was found.
Lyrio RMDC, Narvaez VDC, Chavez CCN
… +4 more, Refai OA, Bold M, Leung N, Herrmann SM
Clin Kidney J
· 2026 Mar · PMID 41877892
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BACKGROUND: Immune checkpoint inhibitor-associated acute interstitial nephritis (ICI-AIN) requires a kidney biopsy for a definitive diagnosis. A recent study suggested that 2-deoxy-2-[18F] fluoro-D-glucose positron emiss...BACKGROUND: Immune checkpoint inhibitor-associated acute interstitial nephritis (ICI-AIN) requires a kidney biopsy for a definitive diagnosis. A recent study suggested that 2-deoxy-2-[18F] fluoro-D-glucose positron emission tomography-computed tomography (F-FDG PET-CT) may offer a noninvasive alternative, but lack of kidney biopsies in all patients and a proper control group receiving ICI therapy remained important limitations. We conducted the first study addressing these limitations and examined whether PET-CT could differentiate biopsy-proven ICI-AIN from other causes of acute kidney injury (AKI) in patients on ICI therapy. METHODS: This retrospective cohort study comprises 105 patients on ICI therapy who underwent F-FDG PET-CT and had a kidney biopsy, along with data from a control group receiving ICIs without AKI. PET-CT scans were performed within 14 days before or 10 days after biopsy, and baseline PET-CTs obtained during ICI therapy before AKI, were reviewed by a blinded nuclear radiologist. Renal cortical standardized uptake values (SUV) were measured in five regions of interest, liver and blood-pool SUVs served as internal references. RESULTS: Thirty-two patients were included (5 ICI-AIN, 7 AKI from other causes, 20 controls). Renal SUVs did not differ significantly among groups. In patients with serial PET-CTs, kidney SUVs tended to increase from baseline to AKI in ICI-AIN, but these changes were not statistically significant. CONCLUSIONS: In this biopsy-validated cohort, PET-CTs did not reliably distinguish ICI-AIN from other causes of AKI in patients receiving ICI therapy. Larger prospective studies are needed to validate these findings.
Uzzo M, Haas M, Jayne DRW
… +7 more, Lightstone L, Parodis I, Rovin B, Seshan SV, Akilesh S, Fogo AB, Bajema I
Clin Kidney J
· 2026 Mar · PMID 41877891
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BACKGROUND: Kidney biopsy is the gold standard for lupus nephritis (LN) diagnosis, with the 2018 International Society of Nephrology (ISN)/Renal Pathology Society (RPS) histopathological classification widely used for pr...BACKGROUND: Kidney biopsy is the gold standard for lupus nephritis (LN) diagnosis, with the 2018 International Society of Nephrology (ISN)/Renal Pathology Society (RPS) histopathological classification widely used for prognosis and treatment decisions. A survey assessing the use of the 2018 ISN/RPS classification in daily practice was recently conducted on behalf of the RPS. METHODS: An online survey was sent to active RPS members after a webinar that introduced RPS members to the topic. The survey contained multiple choice and open-ended questions and remained open 30 days for completion. Results were analysed anonymously. RESULTS: Of 562 RPS members, 185 (32.9%) replied to the questionnaire; 180 (97.8%) were pathologists and 120 of these (64.8%) indicated they encounter >20 biopsies with LN per year. The 2018 ISN/RPS classification and the modified National Institutes of Health activity/chronicity indices are used by 92.4% and 88.1% of respondents, respectively. Respondents rated the utility of both systems with a median score of 8 (interquartile range 7-9) on a 1-10 scale. Suggested improvements to the current classification system include greater standardization and simplicity, clearer definitions for grey-zone entities and the introduction of guidelines for new parameters and biomarkers. CONCLUSIONS: This study shows that the 2018 ISN/RPS LN classification is widely used in everyday practice by pathologists. Our results highlight the need for ongoing refinement to facilitate targeted treatment decisions, particularly considering evolving phenotypes and therapeutic advancements in LN.
Liu N, Ren R, Gou H
… +4 more, Li M, Lan N, Zeng F, Yang B
Clin Kidney J
· 2026 Mar · PMID 41858310
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Conjunctival and corneal calcification, particularly its severe manifestation, band keratopathy, represents a prevalent yet frequently overlooked form of metastatic calcification in end-stage kidney disease (ESKD). This...Conjunctival and corneal calcification, particularly its severe manifestation, band keratopathy, represents a prevalent yet frequently overlooked form of metastatic calcification in end-stage kidney disease (ESKD). This review integrates current evidence on the epidemiology, pathophysiology and interdisciplinary management of uraemic ocular calcification. The pathogenesis is conceptualized through a 'two-hit' model: the systemic 'first hit' involves the specific milieu of chronic kidney disease-mineral and bone disorder driven by hyperphosphataemia, calcium load, secondary hyperparathyroidism and a critical deficiency in calcification inhibitors such as fetuin-A and Klotho. The 'second hit' comprises local ocular triggers, including tear film instability, inflammation and localized alkalosis, which precipitate mineral deposition in the supersaturated environment.
Mitsuno R, Kaneko H, Suzuki Y
… +11 more, Ko T, Okada A, Nakayama T, Azegami T, Takeda N, Morita H, Fujiu K, Yokoo T, Yasunaga H, Takeda N, Hayashi K
Clin Kidney J
· 2026 Mar · PMID 41846585
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BACKGROUND: Myelodysplastic syndromes(MDSs) have been known to be associated with various forms of kidney disease; however, whether they predispose to a longitudinal decrease in kidney function in the general population...BACKGROUND: Myelodysplastic syndromes(MDSs) have been known to be associated with various forms of kidney disease; however, whether they predispose to a longitudinal decrease in kidney function in the general population is unknown. This study aimed to investigate the association between MDSs and the risk of kidney function decline using a large-scale population-based cohort. METHODS: We retrospectively analysed nationwide administrative claims and health checkup data collected between April 2014 and August 2024. MDSs were identified using International Classification of Diseases, 10th Revision codes. Individuals were categorized into two groups according to the presence of MDSs. The primary outcome was a composite kidney outcome, defined as incident end-stage kidney disease, initiation of kidney replacement therapy or a ≥30% decline in estimated glomerular filtration rate. RESULTS: Among 1 659 421 individuals {median age 68 years [interquartile range (IQR) 61-72]; 41.9% male}, MDSs were identified in 901 individuals (0.05%). During a median follow-up of 1092 days (IQR 631-1520), 33 335 individuals experienced the composite kidney outcome. Cumulative incidence curves demonstrated a higher incidence of kidney function decline in individuals with MDSs compared with those without MDSs ( < .001, logrank test). In multivariable Cox regression analysis, the presence of MDSs was independently associated with an increased risk of kidney function decline [hazard ratio 2.28 (95% confidence interval 1.66-3.13)]. CONCLUSIONS: In this large-scale nationwide cohort, MDSs were significantly associated with an increased risk of kidney function decline, positioning MDSs as a clinically relevant kidney risk condition and supporting closer kidney monitoring in this population.
Hammad E, Ali T, Shabana A
… +2 more, Broering D, Nasr R
Clin Kidney J
· 2026 Mar · PMID 41846584
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Calcineurin inhibitor (CNI) pain syndrome is a rare but debilitating adverse effect of CNIs when used in kidney transplant recipients. The pain affects lower limbs and it is usually bilateral and symmetrical. All other c...Calcineurin inhibitor (CNI) pain syndrome is a rare but debilitating adverse effect of CNIs when used in kidney transplant recipients. The pain affects lower limbs and it is usually bilateral and symmetrical. All other causes of foot pain should be excluded before diagnosis. Treatment is not always successful and options are limited as the mainstay is either CNI withdrawal or dose reduction. The available treatments can compromise graft function and lead to reduced graft survival. Herein, we report a case of CNI pain syndrome in a kidney transplant recipient in which belatacept was used successfully. There was complete pain relief and regain of function in affected lower limb. The bone marrow edema also significantly improved on magnetic resonance imaging. Normal kidney functions were maintained on follow-up.
Clin Kidney J
· 2026 Mar · PMID 41822057
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Membranous nephropathy (MN) is a common glomerular disease leading to nephrotic syndrome in adults, clinically characterized by massive proteinuria, hypoalbuminemia, and prominent hyperlipidemia. Growing evidence suggest...Membranous nephropathy (MN) is a common glomerular disease leading to nephrotic syndrome in adults, clinically characterized by massive proteinuria, hypoalbuminemia, and prominent hyperlipidemia. Growing evidence suggests that hyperlipidemia is not merely a secondary consequence of MN, but may also play a critical role in the pathogenesis and progression of MN. This review specifically focuses on hyperlipidemia in MN-rather than nephrotic dyslipidemia in general-to clarify its distinct mechanisms and implications. We examine the association between hyperlipidemia and MN, elucidating the mechanisms from various perspectives including genetic background, the sPLA2-IB/PLA2R axis, the impact of hyperlipidemia on glomerular podocytes and proximal tubule cells, as well as its modulation of immune function. Therefore, this review aims to critically delineate the specific contributions of hyperlipidemia to MN pathology, distinguishing its active role from passive association, and to evaluate the resulting implications for developing targeted therapeutic interventions.
Mirioglu S, Morelle J, Efe O
… +5 more, Hurdogan O, Dirim AB, Kumru G, Lentine KL, Caliskan Y
Clin Kidney J
· 2026 Mar · PMID 41822056
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Thrombotic microangiopathy (TMA) is a pathological condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, and ischemic organ dysfunction due to microvascular endothelial damage and thrombosis. It...Thrombotic microangiopathy (TMA) is a pathological condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, and ischemic organ dysfunction due to microvascular endothelial damage and thrombosis. It affects ∼0.8%-14% of kidney transplant recipients, and may manifest as either a recurrent or disease. While systemic manifestations are commonly anticipated, kidney-limited TMA can also occur and is not rare. Histopathologic examination of allograft biopsies shows morphologic features indicating endothelial injury, and repeated episodes of TMA may result in coexisting acute and chronic lesions within the same patient. In transplant recipients, multiple triggers contribute to endothelial damage, including ischemia-reperfusion injury, antibody-mediated rejection, immunosuppressive agents (calcineurin and mTOR inhibitors), and infections. The risk is particularly important in individuals with genetic variants that dysregulate the alternative complement pathway. In TMA, environmental triggers and transplant-related stressors play a central role, whereas genetic predisposition is the primary factor in recurrent cases. Notably, these mechanisms often overlap and may act synergistically. Recurrent atypical hemolytic uremic syndrome can successfully be managed with terminal complement inhibitors, and prophylactic use of eculizumab in the peri-transplant period has significantly reduced recurrence rates. Management of TMA begins with the identification and removal of precipitating factors. In cases where no clear trigger is found, or when the disease proves refractory to conventional therapy, terminal complement inhibition may be an effective therapeutic option. The prognosis of recurrent TMA has improved substantially with the advent of complement targeting therapies but research is still needed to optimize management strategies.
Özdemir Atikel Y, Lévai E, Schmitt CP
… +21 more, Adalat S, Goodman N, Pınarbaşı AS, Dursun İ, Yazıcıoğlu B, Paglialonga F, Vondrak K, Guzzo I, Printza N, Zagożdżon I, Zurowska A, Atmış B, Bayazıt AK, Tkaczyk M, Faria MDS, Zaloszyc A, Jankauskiene A, Ekim M, Edefonti A, Shroff R, Bakkaloğlu SA
Clin Kidney J
· 2026 Mar · PMID 41822054
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BACKGROUND: Limited data exist on rehospitalization in paediatric dialysis patients. The objective of this study was to identify indications, rates and risk factors for 30-day readmissions in this population. METHODS: We...BACKGROUND: Limited data exist on rehospitalization in paediatric dialysis patients. The objective of this study was to identify indications, rates and risk factors for 30-day readmissions in this population. METHODS: We used a prospective multinational, multicentre cohort study of haemodialysis (HD) and peritoneal dialysis (PD) patients discharged between July 2017 and July 2018. Readmission was identified as repeat hospitalization within 30 days of a prior (index) admission. Potentially preventable readmissions were clinically related to the initial admission. Early readmissions were those occurring within 7 days of discharge. The primary outcome was 30-day readmission. Secondary outcomes included potentially avoidable and early readmissions. RESULTS: A total of 54 (31%) of 176 patients (102 PD, 74 HD) had at least one readmission; 84 (18%) discharges were followed by readmission. PD and HD patients had similar readmission rates {30.4% versus 31.1%; hazard ratio [HR] 1.06 [95% confidence interval (CI) 0.61-1.81]}. Compared with PD, HD patients had a significantly shorter time to readmission (8 versus 14 days; = .019), higher early readmission rates (46% versus 18%; = .010) and risk [odds ratio (OR) 3.87 (95% CI 1.35-11.11)]. Main readmission causes were dialysis access-related non-infectious complications (31%) and access infections (22.7%); 47% of readmissions were potentially avoidable. Lower haemoglobin levels were linked to readmission [HR 0.78 (95% CI 0.64-0.95)]. Bicarbonate use was associated with a 51% lower readmission risk [HR 0.49 (95% CI 0.24-0.99)]. Neurological comorbidity [OR 7.00 (95% CI 1.04-47.22)] and partial recovery [OR 56.45 (95% CI 3.02-1053.10)] were risk factors for avoidable readmission. Risk of avoidable and early readmission decreased with age [OR 0.98 (95% CI 0.97-0.99) and OR 0.99(95%CI 0.98-0.99), respectively]. CONCLUSIONS: Readmissions are common in paediatric dialysis patients, with a substantial proportion being potentially preventable. To reduce rehospitalizations, interventions should target modifiable factors such as access complications, anaemia and incomplete recovery at discharge, while recognizing non-modifiable risks like HD and younger age to identify high-risk patients.
Kim Y, Wu PH, Kwon S
… +11 more, Han SH, Lee J, Lin MY, Chiu YW, Son NH, Paek JH, Kim DK, Han S, Lim CS, Hwang SJ, Lee JP
Clin Kidney J
· 2026 Mar · PMID 41809722
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BACKGROUND: Elevated alkaline phosphatase (ALP) levels are associated with mortality. However, the significance of ALP variability, particularly in chronic kidney disease (CKD), has not been well explored. This study exa...BACKGROUND: Elevated alkaline phosphatase (ALP) levels are associated with mortality. However, the significance of ALP variability, particularly in chronic kidney disease (CKD), has not been well explored. This study examined the associations of baseline ALP and its variability with all-cause mortality and end-stage kidney disease (ESKD) in patients with CKD. METHODS: This retrospective cohort study analyzed data from tertiary hospitals in Taiwan and Korea (2001-2021). Adults with CKD, defined by at least two estimated glomerular filtration rate (eGFR) values <60 ml/min/1.73 m obtained ≥3 months apart, were included. ALP variability was measured using the standard deviation (SD), coefficient of variance (CoV), and variance, categorized into quartiles. The Cox proportional hazards model evaluated the associations between ALP indices, mortality, and ESKD. RESULTS: In the baseline ALP cohort ( = 14 862), higher ALP levels were associated with progressively increased risks of mortality and ESKD, with the highest quartile showing a 1.47-fold higher mortality risk [95% confidence interval (CI) 1.32-1.64] than the lowest. In the variability cohort ( = 12 531), greater ALP variability was significantly associated with increased all-cause mortality (SD, aHR: 1.82, 95% CI: 1.61-2.05; CoV, aHR: 1.50, 95% CI: 1.34-1.68; variance, aHR: 1.81, 95% CI: 1.60-2.04) and showed directionally consistent, although attenuated, associations with ESKD risk. Subgroup analysis stratified by hypertension, diabetes, and cardiovascular disease demonstrated consistent association across comorbidities. CONCLUSION: Given the significant impact of ALP levels and their variability on mortality and kidney disease progression, targeted monitoring and stabilization of ALP over time may help improve long-term outcomes in patients with CKD.