Elshayeb M, Abdulgalil A, El-Husseini A
… +6 more, Elhadedy M, Sally S, Refaie H, Mortada W, Nabieh K, Sobh M
Clin Kidney J
· 2026 Mar · PMID 41800320
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BACKGROUND: Sodium-glucose co-transporter 2 inhibitors have demonstrated renoprotective effects in patients with CKD. However, concerns remain regarding their potential effect on bone mineral metabolism. This study inves...BACKGROUND: Sodium-glucose co-transporter 2 inhibitors have demonstrated renoprotective effects in patients with CKD. However, concerns remain regarding their potential effect on bone mineral metabolism. This study investigated the impact of dapagliflozin on bone health in non-diabetic patients with CKD. METHODS: This randomized, double-blind, placebo-controlled trial enrolled 100 non-diabetic adults with CKD and an estimated glomerular filtration rate (eGFR) of 25-75 ml/min/1.73 m. Participants were randomized 1:1 to receive either dapagliflozin 10 mg daily or placebo for 12 months and stratified by age and eGFR. Serum creatinine, eGFR, urinary protein:creatinine ratio, calcium:creatinine ratio and phosphorus:creatinine ratio were measured at baseline and after 12 months. Bone health was assessed at the same time points using bone formation markers [bone-specific alkaline phosphatase (BSAP), total procollagen type 1 N-terminal propeptide (P1NP)] and bone resorption markers [carboxy-terminal telopeptide of type I collagen (CTX-1), tartrate-resistant acid phosphatase 5b (TRAP-5b)]. Moreover, quantitative computed tomography (QCT) was used to assess volumetric bone mineral density (vBMD). RESULTS: Participants had a mean age of 53.5 ± 11.1 years, with no significant baseline differences between groups. Dapagliflozin significantly reduced proteinuria compared with placebo ( = .012) without significantly affecting eGFR. Both groups experienced significant decreases in BSAP and TRAP-5b levels ( < .001), with no intergroup differences. P1NP remained stable in both groups. CTX-1 levels increased significantly in the placebo group ( = 0.032) but not in the dapagliflozin group without significant intergroup differences. No significant differences in vBMD or T-scores at any lumbar or total lumbar spine were observed between groups after 1 year. CONCLUSIONS: This exploratory randomized controlled trial did not demonstrate any meaningful impact of dapagliflozin on either bone turnover or QCT markers. While these findings provide reassuring preliminary evidence, larger studies are needed to definitively establish long-term bone safety of dapagliflozin in non-diabetic patients with CKD.
Clin Kidney J
· 2026 Mar · PMID 41800319
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Tubulopathies comprise a heterogeneous and still poorly defined group of inherited and acquired disorders in which tubular transport is disproportionately impaired, resulting in chronic electrolyte and acid-base disturba...Tubulopathies comprise a heterogeneous and still poorly defined group of inherited and acquired disorders in which tubular transport is disproportionately impaired, resulting in chronic electrolyte and acid-base disturbances with downstream complications such as nephrocalcinosis, nephrolithiasis, bone fragility and, in some entities, progressive chronic kidney disease. Over the past decade, high-cost targeted therapies have transformed outcomes for a subset of tubulopathy-related disorders with secondary tubular involvement (e.g. anti-fibroblast growth factor 23 therapy in X-linked hypophosphatemia), yet comparable innovations remain largely unavailable for primary tubular transport defects and access to these therapies is uneven across healthcare systems. In this narrative review, we synthesize current evidence and expert recommendations for pragmatic, phenotype-driven interventions that support daily care and may help prevent complications. Core management still relies on non-targeted measures, including individualized nutritional counselling, optimization of hydration and solute load, and tailored electrolyte and alkali supplementation. We also discuss the rational use of widely available drugs that can be repurposed in selected tubular phenotypes, such as thiazide and thiazide-like diuretics, potassium-sparing agents, azole antifungals in calcitriol-driven hypercalcaemic states and emerging data on sodium-glucose cotransporter 2 inhibitors. Finally, we emphasize supportive care components often overlooked in 'drug-centred' approaches, including structured patient education, adherence support and monitoring of extra-renal manifestations. Overall, this review argues for a more resource-conscious approach to tubulopathies: one that recognizes the lack of a consensual definition, prioritizes phenotype-based care bundles, and underscores the urgent need for larger prospective studies incorporating patient-reported outcomes and robust economic endpoints, particularly the out-of-pocket burden borne by patients and families.
Tavakolidakhrabadi N, Ding WY, Welsh GI
… +1 more, Saleem MA
Clin Kidney J
· 2026 Jan · PMID 41788620
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Podocytopathies encompass a spectrum of glomerular disorders driven by structural and functional impairments in podocytes: specialized cells critical for maintaining the glomerular filtration barrier. Dysregulation of ke...Podocytopathies encompass a spectrum of glomerular disorders driven by structural and functional impairments in podocytes: specialized cells critical for maintaining the glomerular filtration barrier. Dysregulation of key podocyte components-such as slit-diaphragm proteins (nephrin, podocin), cytoskeletal regulators (ACTN4, TRPC6), and adhesion complexes (integrins, dystroglycan)-leads to proteinuria and progressive glomerulosclerosis. Current therapies often fail to address underlying genetic or molecular defects, particularly in hereditary or refractory cases. Gene therapy has emerged as a transformative approach, leveraging adeno-associated viral (AAV) vectors, CRISPR-based editing, and RNA modulation to correct pathogenic mutations or restore disrupted pathways. Recent advances in capsid engineering, tissue-specific promoters, and delivery strategies have enhanced podocyte targeting while minimizing off-target effects. Preclinical successes, including AAV-mediated rescue of NPHS2-associated nephrotic syndrome and complement modulation in IgA nephropathy, highlight the therapeutic potential. However, challenges such as immune responses, vector biodistribution, and disease heterogeneity remain. This review synthesizes the molecular mechanisms underlying podocytopathies, evaluates current gene-therapy strategies, and discusses translational hurdles and future directions, including patient-derived organoid models and combinatorial therapies. By bridging mechanistic insights with innovative gene-based interventions, this work underscores the promise of precision medicine in revolutionizing the treatment of podocytopathies.
Chrysochou C, Hamilton A, Tembe K
… +3 more, Pape L, Kanzelmeyer N, Woywodt A
Clin Kidney J
· 2026 Jan · PMID 41788619
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The transition from paediatric to adult renal care is a challenging time for children and young people (CYP). For them, this is a period of seismic change overall and a key step during their journey from parental support...The transition from paediatric to adult renal care is a challenging time for children and young people (CYP). For them, this is a period of seismic change overall and a key step during their journey from parental support to independence. Improving outcomes in paediatric care is resulting in a growing population of CYP who require transition and individualised care planning. The point of transfer to adult services is also a risk escalator to long-term health and it is important to avoid disengagement. Awareness of neurodevelopmental biology and its effects on decision-making is a cornerstone to understanding the behaviour of CYP during this time. There is good evidence to suggest that a holistic approach to transition, rather than simply a formal transfer of care, improves patients' understanding and ability to self-care, and in so doing reduces morbidity and mortality. A coordinated process of transition involves empowerment and shared decision-making and starts in paediatric care aided by transition toolkits. In the absence of a structured transition, CYP often present to adult services unplanned and in a crisis situation. CYP presenting directly to adult services are a particularly vulnerable group with unmet needs due to missing out on a formal transition process. Local innovation, regional initiatives and national policy can help reduce variation and ensure access to good-quality transition care and clinics. Setting up such transition clinics requires careful planning, a multidisciplinary approach and adequate long-term funding. We provide a brief toolkit to set up, run and develop a structured transition service.
Clin Kidney J
· 2026 Jan · PMID 41788618
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BACKGROUND: Efficacy studies have demonstrated the benefits of intradialytic exercise. However, real-world effectiveness trials are lacking. This study evaluated a nationwide clinical implementation of intradialytic exer...BACKGROUND: Efficacy studies have demonstrated the benefits of intradialytic exercise. However, real-world effectiveness trials are lacking. This study evaluated a nationwide clinical implementation of intradialytic exercise settled as a routine practice. Implementation of intradialytic exercise and its effectiveness regarding safety, physical function and body composition were investigated. METHODS: This was a retrospective analysis of the first year of implementation using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance). For effectiveness outcomes, participants ( = 347) were compared with patients who refused the intervention ( = 394), except for physical function in which a pre-post design was performed. Physical function tests included the 8-foot up and go, 30-s sit-to-stand, 5 times sit-to-stand, single leg stance and hand dynamometer. Body composition was determined by multifrequency bioimpedance. RESULTS: Adoption: 20 hemodialysis units adopted the intervention (55.6%). Reach: 1270 patients were eligible (55.8%). The main reason for non-eligibility was physical/cognitive incapacity (50.8%). Of those eligible ( = 1270), 811 (63.9%) started the intervention and 459 (36.1%) refused. Maintenance: attrition rate was 57.2%. Implementation: patients completed 86.3 ± 29.0 min/week of aerobic exercise and adherence was 75.0% ± 19.7%. Effectiveness: there was a lower incidence of cramps in the exercise group ( < .001). No significant differences were found for other adverse events. A significant improvement was observed for all physical function tests, except for handgrip strength. For body composition, significant differences favorable to the exercise group were found for lean tissue mass ( = .045), lean tissue index ( = .013) and body cell mass ( < .001). CONCLUSIONS: Large-scale intradialytic exercise implementation is realistic, safe and effective. Nevertheless, implementation outcomes were limited, and complementary interventions may be needed.
Chaara S, Grooteman MPC, Nubé MJ
… +4 more, Bos WJW, Rootjes PA, Wijngaarden G, de Roij van Zuijdewijn CLM
Clin Kidney J
· 2026 Jan · PMID 41788617
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BACKGROUND: Intradialytic hypotension (IDH) has been associated with both morbidity and mortality. Yet, as IDH often occurs asymptomatic, it might be easily missed with routine twice per hour brachial artery cuff-blood p...BACKGROUND: Intradialytic hypotension (IDH) has been associated with both morbidity and mortality. Yet, as IDH often occurs asymptomatic, it might be easily missed with routine twice per hour brachial artery cuff-blood pressure (BAC-BP) readings. This study evaluated differences in IDH detection between intermittent BAC-BP and continuous BP monitoring with a finger cuff (FC-BP). Validation of the FC device was an additional objective. METHODS: In 40 chronic dialysis patients, intradialytic BP was measured during four sessions using (i) BAC-BP every 15 minutes and (ii) beat-to-beat FC-BP readings, which were averaged over 20-seconds intervals. IDH was defined as a systolic BP (SBP) <90 or <100 mmHg, depending on pre-dialysis SBP. Only FC measurements with an acceptable accuracy (i.e. mean SBP bias ≤10 mmHg) were used for the IDH analysis. For validation, sequential same-arm BP measurements were compared, using Bland-Altman analyses to assess agreement and four-quadrant plots to evaluate concordance. RESULTS: For IDH analysis, 144 BAC-BP readings and 18 163 FC-BP measurements were recorded in 106 hours. While BAC-BP identified 20 IDH episodes, 441 were detected by FC-BP. For validation, Bland-Altman analyses of 1221 paired BP readings showed a mean bias ± limits of agreement of -13.3 ± 44.5 mmHg for SBP and -13.3 ± 25.5 mmHg for diastolic BP. Only 27.7% of the paired FC-BP readings met the acceptable accuracy criterion. Concordance rates were 34.3% and 36.3%, respectively. CONCLUSIONS: First, the occurrence of IDH is severely underestimated with intermittent BP monitoring. Second, FC-BP appears unsuitable for routine intradialytic BP monitoring due to its poor accuracy, precision, and concordance.
Furlano M, Tinoco A, Toso D
… +7 more, Polo A, Martínez O, Llurba E, Espí BC, Maestre F, Marco H, Torra R
Clin Kidney J
· 2026 Jan · PMID 41788616
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Autosomal dominant polycystic kidney disease (ADPKD) is a complex, multisystemic disorder exhibiting notable sex-related differences in clinical presentation, progression and complications. While the disease affects both...Autosomal dominant polycystic kidney disease (ADPKD) is a complex, multisystemic disorder exhibiting notable sex-related differences in clinical presentation, progression and complications. While the disease affects both sexes, disease expression and complications differ significantly between men and women. This review explores the biological, hormonal and psychosocial sex differences in ADPKD across multiple clinical domains. Men tend to experience faster kidney growth, earlier onset of hypertension and slightly younger age at kidney replacement therapy. Women, in contrast, are more susceptible to polycystic liver disease (PLD), often exacerbated by oestrogen exposure, especially during pregnancy or hormonal treatments. Although urinary tract infections are more prevalent among women, cyst infections show no major sex-based difference in incidence, although men may respond less favourably to antibiotic therapy. Cardiovascular complications, intracranial aneurysms and reproductive health risks also show sex-related patterns. Fertility and reproductive counselling must be individualized, as reproductive challenges and risks differ markedly between men and women. Pregnancy in women with ADPKD, especially those with reduced renal function or PLD, carries increased risks and requires specialized care. Fertility in men with ADPKD is usually preserved, although sometimes it may be impaired due to seminal vesicle cysts and sperm morphological abnormalities. However, assisted reproductive techniques generally achieve outcomes comparable to those of unaffected individuals. Psychosocial aspects such as pain, emotional burden and quality of life are also influenced by sex and require integrated management strategies. While tolvaptan slows disease progression in both sexes, pharmacodynamic responses may differ slightly. Incorporating sex-specific insights into ADPKD care, including hormonal and reproductive considerations, is critical to advancing personalized medicine. Understanding these differences will optimize management and improve quality of life for individuals living with ADPKD.
Peters V, Verhoeven N, van der Valk W
… +12 more, Hulsen D, Gerritsen K, van der Schrier D, de Graaf T, van der Sande F, Kamps B, de Jong W, Konings C, Schouten B, Kotanko P, Usvyat L, Larkin J
Clin Kidney J
· 2026 Jan · PMID 41788615
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BACKGROUND: The decommissioning of hemodialysis machines, particularly in the context of transitioning from hemodialysis to hemodiafiltration, remains understudied despite its importance for sustainable healthcare. This...BACKGROUND: The decommissioning of hemodialysis machines, particularly in the context of transitioning from hemodialysis to hemodiafiltration, remains understudied despite its importance for sustainable healthcare. This study evaluates decommissioning strategies for hemodialysis machines used by Dutch hospitals, analyzing the economic, social and environmental consequences. METHODS: A qualitative, exploratory study was conducted through semi-structured interviews with 15 professionals from 11 Dutch hospitals that retired hemodialysis machines. The analysis focused on understanding decommissioning strategies and their economic, social and environmental consequences. RESULTS: Five decommissioning strategies were identified: disposal, donation, reuse, sale and recycling/trade-in. Substantial variability and limited formalization in these strategies were observed across and within hospitals. Economic consequences included repair costs, depreciation and resale value. Social consequences were important, yet typically secondary. Environmental consequences were recognized but rarely formalized, although indirect environmental benefits from economically driven repair activities were acknowledged. CONCLUSIONS: Decommissioning strategies for hemodialysis machines in Dutch hospitals do not use formalized guidelines and are still predominantly shaped by economic drivers. The recognition that each decommissioning strategy entails distinct economic, social and environmental consequences highlights the need for more balanced decision-making. By embedding sustainability principles into hospital policies and standardizing decommissioning procedures, hospitals can move toward more circular and responsible dialysis care.
Alasadi Y, Garcia JC, Arani N
… +7 more, Page V, Geng Y, Andersen CR, Tchakarov A, Kitchlu A, Mamlouk O, Abudayyeh A
Clin Kidney J
· 2026 Jan · PMID 41788614
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BACKGROUND: Among patients receiving immune checkpoint inhibitor (ICI) therapy, the most common renal immune-related adverse event is interstitial nephritis, which is caused by severe T-cell infiltration and is typically...BACKGROUND: Among patients receiving immune checkpoint inhibitor (ICI) therapy, the most common renal immune-related adverse event is interstitial nephritis, which is caused by severe T-cell infiltration and is typically responsive to steroids; although rarer, autoimmune induction in the kidney has also been reported. There is a paucity of data regarding ICI-induced autoimmune disease in the kidney and the challenges associated with continuing ICI therapy. Here, we present a single center case series of ICI-induced glomerulonephritis with data on treatment rechallenge. METHODS: We retrospectively reviewed 241 patients who underwent kidney biopsies at our institution between 2015 and 2024 and identified those who had non-vasculitis-associated glomerulonephritis after ICI therapy. Demographics, renal toxicity, renal response, disease response, and overall survival data were extracted from the patients' medical records. We defined renal response based on creatinine and proteinuria using KDIGO guidelines. We also performed a literature review to identify published cases of ICI-induced glomerulonephritis. Differences between treatment groups were assessed with a two-sided, two-sample -test and Wilcoxon test or with a chi-square test, as appropriate. RESULTS: Among 241 kidney biopsies we identified 16 patients with non-vasculitic GN, eight received rituximab with or without corticosteroids, and eight received corticosteroids only, for ICI-induced glomerulonephritis. The median proteinuria grades in the rituximab and corticosteroid groups were 3 and 1, respectively. The median corticosteroid treatment duration in the rituximab group (2.5 weeks) was shorter than that in the corticosteroid group (8 weeks). In the rituximab group, 75% of patients underwent ICI rechallenge and had no proteinuria relapse. Patients who received rituximab had better change in proteinuria response than those who received corticosteroids ( value = .029). Among the 42 patients we identified from the literature review, renal response did not differ significantly between the 10 who received rituximab and the 32 who did not. CONCLUSION: Use of Rituximab in treatment of ICI-induced GN is an attractive option to reduce steroids exposure allowing continued ICI treatment for overall improved renal outcome. Clinical trials to evaluate these findings are needed.
Weldingh FLU, Herlin MK, Steffensen EH
… +3 more, Heide-Jørgensen U, Vogel I, Christiansen CF
Clin Kidney J
· 2026 Feb · PMID 41788227
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BACKGROUND: It is unclear whether individuals with Down syndrome (DS) are at increased risk of kidney disease. This study aims to examine the risk of acute kidney injury (AKI) and chronic kidney disease (CKD) in individu...BACKGROUND: It is unclear whether individuals with Down syndrome (DS) are at increased risk of kidney disease. This study aims to examine the risk of acute kidney injury (AKI) and chronic kidney disease (CKD) in individuals with DS compared with the general population. METHODS: Using the Danish Cytogenetic Central Registry, we identified a population-based cohort of individuals with genetically confirmed DS in Denmark between 1961 and 2021. For each individual with DS, we sampled 10 age- and sex-matched individuals without DS from the general Danish population. We used laboratory data on plasma creatinine from the 1990s until 2024 to assess AKI and CKD and computed the cumulative incidence (risk) of AKI and CKD by age. Furthermore, we estimated the risk of AKI and CKD in individuals without congenital heart disease (CHD). RESULTS: We identified 2815 individuals with DS and available laboratory data on plasma creatinine measurements. Comparing individuals with DS to the matched cohort, the risk of AKI was 28.9% vs 1.4% at age 20, 32.8% vs 5.3% at age 40 years, and 48.6% vs 23.8% at age 70 years. The risk of CKD was 1.2% vs 0.1% at age 20, 3.9% vs 0.4% at age 40 years, and 23.2% vs 13.8% at age 70 years. For individuals without CHD, the risk of AKI and CKD remained considerably higher for individuals with DS than for matched individuals. CONCLUSIONS: Individuals with DS were at increased risk of both AKI and CKD compared with the general population. Kidney disease should be considered during clinical follow-up of DS.
Prasad M K H, Pursnani LK, Mahapatra HS
… +5 more, Balkrishnan M, Binoy R, Dev V, Yadav V, Arora D
Clin Kidney J
· 2026 Mar · PMID 41777681
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BACKGROUND: Tunnelled catheter-related bloodstream infections (CRBSIs) in haemodialysis (HD) are challenging to manage due to biofilm formation. Ethanol lock therapy (ELT) has demonstrated potential as an adjunct to anti...BACKGROUND: Tunnelled catheter-related bloodstream infections (CRBSIs) in haemodialysis (HD) are challenging to manage due to biofilm formation. Ethanol lock therapy (ELT) has demonstrated potential as an adjunct to antibiotics for catheter salvage, but robust evidence is limited. METHODS: We conducted a single-centre, open-label, randomised controlled trial of adult HD patients with suspected or confirmed CRBSI. Patients received either 70% ELT plus intravenous antibiotics or intravenous antibiotics alone. Primary outcome was catheter salvage at day 7. Secondary outcomes included recurrence at day 60, catheter survival and adverse events. RESULTS: Eighty-four patients were randomised (42 per arm). Coagulase-negative was the most common pathogen (34.5%). Early catheter salvage was higher with ELT (78.6% versus 57.1%; = .035). Recurrence was lower with ELT at day 60 (20.5% versus 53.7%; = .002). The median catheter survival was longer (15 versus 8 days), although not statistically significant ( = .283). Fever resolution by day 7 was significantly higher in the ELT group compared with controls (64.3% versus 35.7%; = .009). Adverse events were infrequent and mild. In multivariate analysis, higher serum albumin was independently associated with an increased likelihood of catheter salvage [odds ratio (OR) 2.43, = .038], while longer dialysis vintage (OR 0.90, = .035) and infection (OR 0.05, = .014) were associated with reduced salvage rates. CONCLUSION: Adjunctive ELT improved early catheter salvage and reduced recurrence without significant adverse effects. These findings support its use as part of salvage protocols in tunnelled catheter infections.
Høyer S, Heide-Jørgensen U, Jensen SK
… +2 more, Pottegård A, Christiansen CF
Clin Kidney J
· 2026 Mar · PMID 41777679
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BACKGROUND: Acute kidney injury (AKI) is associated with increased morbidity and mortality but is likely underrecorded in health registers. This study examined the sensitivity and positive predictive value (PPV) of AKI d...BACKGROUND: Acute kidney injury (AKI) is associated with increased morbidity and mortality but is likely underrecorded in health registers. This study examined the sensitivity and positive predictive value (PPV) of AKI diagnoses compared with laboratory-identified AKI. METHODS: In this observational study we analysed data from the Danish National Patient Register and laboratory databases from January 2007 through November 2023. Diagnoses of AKI according to the International Classification of Diseases, 10th Revision (ICD-10) were compared with laboratory-identified AKI episodes defined by the Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria. Sensitivity was defined as the proportion of laboratory-identified AKI episodes captured by ICD-10 codes within 30 days before or after the episode's index date and PPV was the proportion of ICD-10-coded AKI episodes confirmed by the KDIGO criteria within a ±30-day window. Analyses were stratified by sex, age, AKI stage, setting, comorbidity and short-term mortality. RESULTS: A total of 947 209 laboratory-identified AKI episodes and 80 649 ICD-10-coded AKI episodes were included. Overall, sensitivity was 7.5% [95% confidence interval (CI) 7.4-7.5], varying by stage (4.0% for stage 1 versus 21.7% for stage 3) and setting (6.0% for hospital acquired versus 8.6% for community acquired). The overall PPV was 90.6% (95% CI 90.4-90.9), with little variation across subgroups. CONCLUSION: ICD-10 codes of AKI demonstrate a high PPV, ensuring accuracy in identifying true AKI episodes. However, the low sensitivity highlights a risk of underestimating AKI occurrence. Laboratory data should be prioritized for comprehensive AKI identification and potential biases addressed when relying on diagnosis codes in research.
Clin Kidney J
· 2026 Feb · PMID 41737700
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Muscle cramps are common in patients undergoing haemodialysis, but their pathophysiology is not well understood. The effect of regional blood flow reduction on the neuromuscular compartment as a result of a high-flow art...Muscle cramps are common in patients undergoing haemodialysis, but their pathophysiology is not well understood. The effect of regional blood flow reduction on the neuromuscular compartment as a result of a high-flow arteriovenous fistula (HFAVF) was not previously implicated in dialysis-associated muscle cramps. We report a patient with HFAVF (blood flow rate 2450 ml/min) causing high cardiac output failure who developed severe muscle cramps during dialysis, significantly limiting ultrafiltration and causing fluid overload. Ligation of the fistula resulted in complete reversal of muscle cramps, allowing for adequate ultrafiltration. This case highlights the need for clinical vigilance and potential screening for HFAVF in dialysis patients presenting with persistent muscle cramps.
Burton JO, Frankel AH, Kwon K
… +4 more, Marqués M, Jiang G, Wang J, McCafferty K
Clin Kidney J
· 2026 Feb · PMID 41737699
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Chronic kidney disease (CKD) affects approximately 10% of adults worldwide and is associated with an elevated risk of cardiovascular disease, such as heart failure, and increased prevalence of comorbidities such as type...Chronic kidney disease (CKD) affects approximately 10% of adults worldwide and is associated with an elevated risk of cardiovascular disease, such as heart failure, and increased prevalence of comorbidities such as type 2 diabetes. Early CKD diagnosis and intervention are crucial to prevent progression to advanced kidney disease, which imposes a significant clinical and economic burden on health systems and patients alike. Despite the availability of global CKD management guidelines, adherence remains low, particularly with respect to the use of sodium-glucose cotransporter 2 inhibitors (SGLT2is), which offer strong cardiorenal benefits particularly when initiated in a timely manner. This gap underscores the urgent need for practical solutions to translate existing guideline recommendations into improved clinical practice across the CKD management pathway, encompassing screening, treatment initiation and referral. This manuscript highlights successful global initiatives in CKD management, presenting a 'call-to-action' to support healthcare systems and providers in achieving improved CKD management worldwide. By bringing together eight diverse 'Champions of Change' initiatives from various health systems, this paper presents innovative and transformative solutions across the entire CKD management pathway, from early diagnosis to treatment. These case studies underscore the potential of tailored, context-specific strategies for transforming CKD care. By adopting core principles such as proactive screening, risk stratification strategies, multidisciplinary collaboration, knowledge-sharing and patient-centred approaches, healthcare systems and providers can adapt these successful models to their local settings, thereby advancing global efforts to prevent CKD progression and improve patient outcomes.
Liu ZY, Zhang YL, Li Y
… +8 more, Han JF, Song ZR, Zhang JY, Qu TH, Xu R, Zhang H, Chen XL, Zhou XJ
Clin Kidney J
· 2026 Feb · PMID 41725785
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BACKGROUND: Monogenic causes are increasingly recognized in end-stage kidney disease (ESKD), but the real-world diagnostic efficacy of exome sequencing in unselected dialysis cohorts is still being defined. METHODS: We c...BACKGROUND: Monogenic causes are increasingly recognized in end-stage kidney disease (ESKD), but the real-world diagnostic efficacy of exome sequencing in unselected dialysis cohorts is still being defined. METHODS: We conducted a prospective study enrolling 317 adult ESKD patients from a single center in Taiyuan, China, regardless of presumed etiology. Whole-exome sequencing (WES) was performed on peripheral blood DNA. Variants were curated and classified per the American College of Medical Genetics and Genomics/Association for Molecular Pathology (ACMG/AMP) 2015 and Association for Clinical Genomic Science (ACGS) guidelines, with only "pathogenic" or "likely pathogenic" findings considered diagnostic. RESULTS: The cohort was 59% male, mean ESKD onset 53.2 ± 14.3 years. A definitive monogenic diagnosis emerged in 7.3% (23/317) of patients, in line with multicenter and international studies. Genes most frequently implicated were (3.5% of cohort; 47.8% of genetically diagnosed) and (1.9%; 26.1% of diagnosed), reflecting global trends of autosomal dominant polycystic kidney disease and Alport syndrome as major genetic contributors in adult ESKD. Notably, mutations in , , or , causing hereditary steroid-resistant nephrotic syndrome, led to significantly earlier ESKD onset (mean 31.3 years) compared with or -related cases. Inconclusive genetic findings were present in 7.9% (25/317). Most patients reported no family history of kidney disease, indicating the limitations of clinical suspicion alone. CONCLUSIONS: In a real-world Chinese dialysis cohort, WES provided a molecular diagnosis in 7.3% of cases, demonstrating clinical utility for risk stratification, family counseling, donor selection and actionable therapy. These findings underscore the need for routine integration of genetic testing in ESKD care irrespective of family history, especially to clarify ambiguous cases and optimize management.
Montez de Sousa IR, Gjerstad AC, Jankauskiene A
… +29 more, Spasojević B, Tönshoff B, Parmentier C, Shtiza D, Askiti V, Reusz G, Novljan G, Mihneva-Kirilova G, Zagożdżon I, Stojanovic J, Hogan J, Vondrak K, Rocha L, Podracka L, Molchanova MS, Ten Dam MAGJ, Abazi-Emini N, Dönmez O, Baiko S, Bakkaloglu SA, Sørensen SS, Fomina SP, Jahnukainen T, Lundgren T, Edvardsson V, Magadi W, Jager KJ, Stel VS, Bonthuis M
Clin Kidney J
· 2026 Feb · PMID 41710046
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BACKGROUND: Kidney transplantation (KT) is the preferred treatment for paediatric patients with kidney failure, but information on trends in paediatric KT in Europe is lacking. We aimed to report on time trends in paedia...BACKGROUND: Kidney transplantation (KT) is the preferred treatment for paediatric patients with kidney failure, but information on trends in paediatric KT in Europe is lacking. We aimed to report on time trends in paediatric (0-17 years) KT rates and recipient characteristics in Europe between 2010 and 2021. METHODS: Thirty-one countries contributing data from 2010 to 2021 on paediatric KT to the European Society for Paediatric Nephrology/European Renal Association Registry were included. We reported trends in KT rates [per million age-related population (pmarp)], overall and by patient subgroup for Europe, and at macro-economic and country-specific levels. We also reported clinical variables in the first year post-KT. The 2020-21 period was analysed separately to account for the COVID-19 pandemic. RESULTS: The paediatric KT rate was stable at ≈5 pmarp between 2010 and 2019, and about one-fourth were pre-emptive KTs. In 2020-21 the KT rate was 5.6 pmarp. In low-, middle- and high-gross domestic product (GDP) countries, KT rates (pmarp) were 2.1, 6.1 and 7.6, respectively, and increased in low-GDP countries by 4.1% per year from 2010 to 2019, mainly in the youngest recipients. The proportion of pre-emptive KT increased only in middle-GDP countries. Low-GDP countries showed a higher prevalence of short stature while high-GDP countries showed more overweight/obese, hypertensive and anaemic patients. CONCLUSIONS: The rate of paediatric KT in Europe has remained stable, with differences between GDP groups. Low-GDP countries had the lowest KT rates, but with an increasing trend over time. Opportunities to further increase access to paediatric KT should be explored.