Obesity is a recognized risk factor for chronic kidney disease (CKD), but whether weight change is associated with CKD remains unclear. This research aimed to investigate the relationship between weight change patterns across adulthood and the risk of CKD.

Data for 34,187 adults participating in the National Health and Nutrition Examination Survey 1999-2020 were analyzed. The weight change patterns of participants were assessed across different time intervals, including transitions from obesity to non-obesity, non-obesity to obesity, and remaining stable obesity. Absolute weight changes were also analyzed, categorizing participants into various weight gain and loss groups. Furthermore, stratified analyses were conducted to explore potential interactions between age, sex, and smoking status about CKD risk.

The study found that individuals transitioning from obesity to non-obesity, non-obesity to obesity, and remaining stable obesity had an elevated risk of developing CKD throughout adulthood compared to those maintaining stable non-obesity weight patterns. Moreover, a J-shaped or U-shaped relationship was observed between CKD risk and absolute weight changes, with both extreme weight gain (≥20 kg) and substantial weight loss (>2.5 kg) associated with increased CKD risk. Stratified analyses revealed that age and sex played significant roles in these associations, with stronger effects observed among participants under 60 years at baseline.

This study underscores the link between weight change across adulthood and the risk of CKD. Maintaining a stable weight and avoiding extreme weight fluctuations may reduce CKD risk. These insights can be considered when developing CKD prevention and management strategies.

Kidney transplantation remains the preferred treatment for patients with end-stage kidney failure. Complement-dependent cytotoxicity (CDC) crossmatch (CDC-XM) and human leukocyte antigen (HLA) typing are two important methods of donor-recipient matching prior to kidney transplantation. The purpose of the present study was to explore the effects of CDC-XM levels and HLA matching on early post-operative clinical outcomes in kidney transplant recipients. A total of 112 consecutive recipients who underwent allogeneic kidney transplantation were selected and their data collected, including pre-operative general information, indicators associated with renal function, red blood cell and white blood cell counts, the blood glucose level at each follow-up time point and both the incidence of adverse events following transplantation and their risk factors. During the follow-up period, statistical methods were used to compare and systematically analyze the differences in clinical indicators and adverse events between each groups. In each different groups that were assigned for the CDC-XM levels and HLA matching, the differences in the clinical indicators between the groups during the follow-up period were mainly centered on the first week post-transplantation, with the greatest differences being identified for the renal function-associated indicators, whereas the observed recovery was essentially comparable between 1-6 months. According to the multivariate analysis, recipients of age ≥40 years and with a BMI ≥25 tended to have an increased risk of delayed graft function (DGF), whereas the risk was reduced when the organ had been donated by a living donor and also when the number of HLA mismatches was 0-2. In conclusion, the present study showed that CDC-negativity and improved HLA matching help to promote the recovery of renal function in kidney transplant recipients during the early post-operative period. Patients who met the conditions of CDC-negativity and fewer HLA mismatches had faster and improved early postoperative recovery of renal function and a lower incidence of DGF. Furthermore, in a multifactorial analysis of DGF, recipient age, recipient BMI, donor type and HLA mismatch were found to be important risk factors for DGF.

Currently, the joint and independent effects of intake of multiple dietary vitamins (including vitamin A, B1, B2, B6, B12, C, D, E, and K) on the prevalence of cardiovascular disease (CVD) in the chronic kidney disease (CKD) population are unclear, so this study was conducted to investigate mainly this point.

We collected National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2016. We performed weighted multivariate logistic regression models to analyze the association of single dietary vitamins intake with CVD. Additionally, we examined the co-exposure of nine dietary vitamins, defined as their concurrent intake, and evaluated the potential additive or interactive effects of co-exposure of nine dietary vitamins on CVD risk in CKD patients using Bayesian kernel machine regression (BKMR) and weighted quantile sum (WQS) regression.

Finally, 2,203 CKD participants (weighted n = 27,120,429) were included, and 622 had CVD, with a CVD prevalence of 28.2%. In the fully adjusted model, by comparing the third tertile with the first tertile, the adjusted OR [T3 vs. T1] for the effect of vitamin B6 on CVD prevalence was 0.67 (95% CI, 0.51-0.89, p-value = 0.01), while that of vitamin E was 0.61 (95% CI, 0.42-0.87, p-value = 0.01). In the WQS model, the intake of nine dietary vitamins was negatively correlated with CVD prevalence (OR: 0.81, 95% CI: 0.70-0.93, p-value = 0.004). In the BKMR model, when the concentration was between the 25th and 75th percentiles, there was an overall negative correlation between the total intake of nine dietary vitamins and CVD prevalence.

High intakes of vitamin B6 and vitamin E were associated with low CVD risk in CKD patients, respectively. Additionally, nine dietary vitamins (vitamins A, B1, B2, B6, B12, C, D, E, and K) co-exposure were inversely correlated with the CVD prevalence in the CKD populations.

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a novel lipid index. Prior research has established a connection between lipid irregularities and chronic kidney disease (CKD). This study aims to establish a possible link between NHHR and CKD. Data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2003 to 2016 was used to examine the relationship between NHHR and CKD among the elderly population. This research utilized weighted logistic regression, smoothed curve fitting and subgroup analyses along with interaction tests to evaluate the association between NHHR and CKD. The findings reveal a positive correlation between NHHR and CKD in fully adjusted Model 3. Besides, NHHR had a J-curve relationship with CKD. Subgroup analysis indicated that compared with those with lower body mass index (BMI), individuals with higher BMI are more prone to CKD. Research has shown that increased NHHR levels are associated with a higher likelihood of developing CKD in individuals aged above 60 in the United States. NHHR's role in lipid metabolism suggests it might be an effective marker for tracking CKD's progression.

Chronic kidney disease (CKD) is associated with poor psychological well-being. Whether early-stage CKD is a risk factor for suicide warrants further research.

This nationwide, retrospective, cohort study aimed to evaluate the risk of suicide in patients with early-stage CKD and identify the associated risk factors. A total of 3.945,198 individuals aged ≥ 19 years who underwent the 2009 national health screening in South Korea were studied. Among them, 202,291 patients had early-stage CKD (estimated glomerular filtration rate (eGFR) ≥ 30 and < 60 mL/min per 1.73 m2 and/or dipstick albuminuria ≥ 1 +). The study outcome was suicide as confirmed by the nationwide death register based on death certificates.

The study population had a mean age of 59 ± 15 years, and 47% were male. We identified 930 suicides (incidence rate, 0.45 per 1000 person-years) in the CKD group and 11,332 suicides (incidence rate, 0.27 per 1000 person-years) in the non-CKD group. Early-stage CKD was significantly associated with an increased risk of suicide in multivariable analysis adjusted for demographic characteristics; lifestyle habits; comorbidities, including diabetes and hypertension; economic status; and depression, bipolar disorder, schizophrenia (hazard ratio, 1.18; 95% confidence interval 1.10‒1.26). Suicide incidence was higher in individuals with proteinuria but preserved kidney function (eGFR > 60 mL/min per 1.73 m2 and dipstick albuminuria > 1 +) than in those without CKD.

Healthcare providers may need to examine the mental health of patients with early-stage CKD to prevent suicide.

Exposure to air pollutants, especially fine particulate matter (PM2.5), has been recognized as a major contributor to the increasing prevalence of kidney diseases. However, until now, evidence for the translocation of airborne nanoparticles (NPs) in the human kidney has been lacking, hindering the understanding of the relationships between PM2.5 exposure and kidney diseases. Here, we report the discovery and analysis of airborne magnetite nanoparticles in human kidney stones (with mass concentrations ranging from 363 to 740 ng/g dry tissue weight) by high-resolution microstructural characterization. Notably, we established a methodology for highly selective extraction and accurate characterization of distinctive magnetite NPs and identified the abundant presence of these NPs with a distinctive core-shell structure of Fe3O4/SiO2 in both kidney stones and human blood. We demonstrate that such distinctive core-shell magnetite NPs are indicative of a coal-burning source. Hence, magnetite NPs deposited in the human kidneys in this study area most likely derived from air pollution emissions from coal-fired power plants and were transported via blood circulation to the kidney. Our results provide compelling evidence for understanding the systemic health risks of exposure to nanoparticulate, Fe-bearing air pollution and the associations observed between kidney diseases and PM2.5 exposure.

Intradialytic hypotension (IDH) is a common phenomenon during hemodialysis (HD), with profound complications and all-cause mortality. Data on IHD is scarce in Sub-Saharan Africa. The study aimed to evaluate the incidence, risk factors, and outcome associated with recurrent IDH among patients on maintenance HD.

This was a retrospective cohort study conducted at the Kilimanjaro Christian Medical Centre HD unit between August 1, 2021 and July 31, 2022. In the study, 39 met the inclusion criteria, and a total of 4706 HD sessions were analyzed. The predictor was the occurrence of recurrent IDH. The outcomes were mortality from IDH, hospital admission due to IDH, and termination of the respective HD session. Descriptive statistics for categorical and continuous variables. A χ 2 test was used to identify associations, and the receiver operating characteristics curve was used to determine the cutoff threshold for different parameters in determining risk factors for recurrent IDH.

The incidence of IDH was 4.35%; 46.3% of these IDH episodes were recurrent. Risk of IDH was higher in patients with pre-dialytic serum inorganic phosphate levels > 1.8 mmol/L (RR: 2.33, 95% CI: 1.02-5.35, p < 0.001) with a predicted threshold of 1.27 mmol/L by ROC curve (AUC 0.618, CI: 0.541-0.694, sensitivity 60%, specificity 40%), among males (aRR: 9.65, CI: 2.27-40.85, p = 0.002). A systolic blood pressure of < 140 mmHg had a significant protective effect (aRR: 0.34, CI: 0.17-0.69, p = 0.003).

Recurrent IDH is more common in males, among patients with hyperphosphatemia, and shows seasonal variations. Systolic blood pressure of < 140 mmHg confers a protective effect against recurrent IDH.

Patients with chronic kidney disease (CKD) frequently develop uremic cardiomyopathy, characterized by mitochondrial dysfunction as one of its pathologically significant mediators. Given that PM2.5 specifically targets cardiac mitochondria, exacerbating toxicity, this study addresses the potential alterations in the severity of PM2.5 toxicity in the context of CKD conditions. Female Wistar rats were exposed to PM2.5 at a concentration of 250 μg/m3 daily for 3 h for 21 days after which an adenine-induced CKD model was developed. While both PM2.5 exposure and the induction of CKD in rats lead to cardiomyopathy, the CKD animals exposed to PM2.5 exhibited a notably severe extent of myocardial hypertrophy and fibrosis. ECG recordings in CKD+ PM2.5 animals revealed a depressed ST segment and prolonged QRS interval, with both PM2.5 and CKD animals displaying an elevated ST segment. Subcellular level analysis confirmed a significantly low mitochondrial copy number and a severe decline in mitochondrial bioenergetic function in the CKD+ PM2.5 group. The prominent decline in PGC1-α further affirmed the severe mitochondrial functional deterioration in CKD+ PM2.5 animals compared to other experimental groups. Additionally, myocardial calcification was enhanced in CKD+ PM2.5 animals, heightening the susceptibility of CKD animals to PM2.5 toxicity. In summary, our findings suggest that the increased vulnerability of CKD myocardium to PM2.5-induced toxicity may be attributed to severe mitochondrial damage and increased calcification in the myocardium.

Chronic kidney disease (CKD) presents a significant global health challenge. Nephrology nurses, possessing specialized competencies, play an essential role in providing high-quality care to CKD patients.

This scoping review aims to comprehensively map and synthesize literature on the competencies of nephrology nurses worldwide.

A scoping review was reported using the PRISMA-ScR framework and aligned with the Joanna Briggs Institute (JBI) methodology. The population, concept, and context (PCC) model was employed to formulate the research question. The search was conducted between June and July 2023 across five databases:Medline, Scopus, Cochrane Library, ASSIA, and CINAHL, with additional consultation of gray literature sources. Screening of articles, data extraction, and quality appraisal were independently performed by two authors. Critical appraisal was conducted using JBI critical appraisal tools. Data were analyzed using descriptive analysis.

Of the 8786 records identified, 25 were included. The included articles predominantly consisted of position papers published between 2000 and 2022, with studies conducted across all continents. Core competencies for nephrology nurses were identified, along with advanced competencies encompassing advanced clinical practice, education, leadership and management, and research.

The review of competencies among nephrology nurses worldwide reveals a comprehensive and diverse set of skills required to address the complexities of CKD. As the field of nephrology continues to evolve, ongoing efforts should be directed toward refining and expanding the competencies of nephrology nurses in individual national contexts as well as defining, in the light of a systematic mapping of skills, homogeneous training paths.

This scoping review aims to synthesize global literature on nephrology nurses' core and advanced skills, providing a foundation for defining competencies at both national and institutional levels.

Chronic kidney disease (CKD) is a major health concern globally, with more than 850 million people suffering from it. Several studies have been carried out to reduce inflammation in CKD patients; and to study the relationship between gut microbiota and inflammation.

The effect of herbal formulations to improve the gut flora and reduce inflammation has not been studied earlier. The study aims to evaluate effect of herbal formulation combined with standard of care (SOC) treatment compared to SOC.

A prospective, randomized, parallel group clinical trial was planned on 90 patients split equally into standard of care (SOC) with herbal treatment (IP) and only SOC groups. The change in the abdominal pain score, percent change in the pathogenic and non-pathogenic microbiome were the key endpoints of interest. The safety assessment was in terms of adverse events, changes in hematological and biochemical parameters.

The demographic and other patient characteristics showed statistically non-significant differences between two groups. On day 90, the median abdominal score in SOC + IP group (2.00) was significantly lower than that of SOC group (3.00) (p = 0.002). The quality of life score improved significantly in SOC + IP group (p < 0.001), unlike SOC group. There was significant reduction in pathogenic microbes in SOC + IP group; however, the reduction in non-pathogenic microbes was non-significant in this group. The adverse events (AEs) were in mild form, and the proportion of patients with AEs differed non-significantly between two groups.

The IP supplementation along with SOC significantly improved the GUT micro flora, and improved the overall quality of life of CKD patients. This treatment combination can be practiced for effective patient management.

The prevalence of chronic kidney disease (CKD) is rising, increasing demand for renal replacement therapy (RRT). Community pharmacies, as accessible healthcare hubs, can play a pivotal role in CKD prevention. This study aimed to develop care models for community pharmacies to optimize medication use, encourage behavior modification, and promote self-management among at-risk individuals.

Conducted between June 2017 and July 2018, this study utilized an action research approach. Microalbuminuria was assessed using urine dipsticks, and pharmacists applied behavioral change and self-management support (SMS) strategies to slow CKD progression. Participants were categorized by albuminuria levels and enrolled in pharmacist-led care programs, with follow-up assessments at weeks 0 and 12.

Of 521 participants screened, 57% tested positive for albuminuria. For these individuals, serum creatinine testing and referrals to primary care were initiated. Self-management behavior assessment (S1) scores significantly improved (p = 0.024). Key factors associated with urine albumin levels included age < 60 years (OR = 0.44), diabetes (OR = 3.69), hypertension (OR = 2.01), BMI < 27.5 kg/m2 (OR = 0.42), eGFR ≥ 60 mL/min/1.73 m2 (OR = 3.34), lower systolic (OR = 0.55) and diastolic blood pressure (OR = 0.34), and fasting plasma glucose < 126 mg/dL (OR = 0.29).

Community pharmacist-led albuminuria screening effectively supports CKD prevention and enhances self-awareness within communities.

Urolithiasis, or kidney stones, has emerged as a significant public health concern. Despite this, effective treatments targeting stone formation and recurrence are limited. This review delves into the molecular mechanisms underlying the condition. Investigating these molecular aspects can address existing gaps in treatment options. Future research can uncover new therapeutic strategies by targeting downstream pathways, and effector molecules. Cell signaling pathways offer potential targets, as they involve complex interactions that can be modulated to address multiple clinical symptoms. An imbalance in calcium and oxalate levels can lead to kidney stone formation which is characterized by oxidative stress, inflammation, and cell death. The interplay between key organelles like the endoplasmic reticulum and mitochondria triggers stress pathways, including oxidative stress and apoptosis. This review consolidates recent advances in understanding the pathophysiology and signaling events associated with kidney stones.

Multimorbidity is increasingly prevalent in lower- and middle-income countries. Health-related quality of life (HRQOL) has been inversely associated with multimorbidity but is understudied in lower- and middle-income countries. We report cardiovascular disease (CVD) multimorbidity in Haiti and its association with HRQOL.

We used data from the Haiti CVD Cohort, a population-based longitudinal cohort of adults. CVD multimorbidity was 2+ CVD risk factors/diseases at enrollment. HRQOL was measured using the Short Form-12, yielding physical component summary/mental component summary scores between 0 and 100, with higher scores indicating better HRQOL. We used linear regressions to assess the association between CVD multimorbidity and HRQOL and individual CVD comorbidities and HRQOL. Additionally, we examined sex and education as potential effect modifiers. Among 2,996 participants, the median age was 40 years (interquartile range [IQR], 27-55), 58.0% were women, and 70.3% earned <1 US dollar per day. CVD multimorbidity prevalence was 24.1%; compared with those without CVD multimorbidity, those with CVD multimorbidity were older (median age, 56.0 years [IQR, 47.0-53.0]) and women (70.5%). Adjusted models revealed CVD multimorbidity was inversely related to physical component summary (-2.7 [95% CI, -3.8 to -1.6]) and mental component summary (-1.0 [95% CI, -1.8 to -0.2]). Heart failure and hypertension showed the strongest CVD morbidities associated with poor HRQOL. In the interaction analysis, among men, CVD multimorbidity was associated with a 4.3-point lower physical component summary score. Among those with less education, CVD multimorbidity was associated with a 4.6-point lower physical component summary score than no CVD multimorbidity.

Our data are among the first to describe HRQOL data with high CVD multimorbidity in a young population in urban Haiti, and CVD multimorbidity was associated with decreased HRQOL.

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03892265.

The clinical landscape for the treatment of patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) is rapidly evolving. As part of the FOUNTAIN platform (NCT05526157; EUPAS48148), we described and compared cohorts of adult patients with CKD and T2D initiating a sodium-glucose cotransporter 2 inhibitor (SGLT2i) before the launch of finerenone in Europe, Japan, and the United States (US).

This was a multinational, multi-cohort study of patients with T2D in five data sources: the Danish National Health Registers (DNHR) (Denmark), PHARMO Data Network (The Netherlands), Valencia Health System Integrated Database (VID) (Spain), Japan Chronic Kidney Disease Database Extension (J-CKD-DB-Ex) (Japan), and Optum's de-identified Clinformatics® Data Mart Database (CDM) (US). Eligible patients had CKD (based on either diagnosis codes, eGFR values, and/or urine ACR) and initiated an SGLT2i between 2012 and 2021. Baseline demographic, lifestyle, and clinical characteristics were analyzed, and drug utilization patterns were described.

The final cohorts included 21,739 patients in DNHR, 381 in PHARMO, 31,785 in VID, 1157 in J-CKD-DB-Ex, and 56,219 in CDM. Across data sources, approximately 41-70% had CKD stage 1 or 2 at baseline; severe CKD (stage 4) was uncommon (1.6-6.7%). The median duration of SGLT2i therapy ranged from 7.5 months in PHARMO to 17.0 months in VID. At least 50% of patients were currently receiving SGLT2i treatment at 1 year after initiation.

At a 1-year follow-up, at least half of the patients with CKD and T2D were receiving SGLT2i treatment across the data sources. In patients initiating SGLT2i, treatment options for T2D and CKD were heterogeneous and dynamic within and among data sources.

Myeloperoxidase (MPO) is an oxidative stress biomarker, with elevated MPO levels linked to chronic kidney disease (CKD) progression. Metal exposure is a risk factor for CKD, and is also correlated to MPO expression, with specific MPO genotypes linked to MPO expression. Therefore, we examined whether MPO plasma levels or MPO polymorphisms were linked to CKD, and explored whether these factors modified associations between CKD and metal concentrations. Accordingly, we recruited 395 age- and sex-matched controls and 215 patients with CKD (persistent estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 for a minimum of 12 weeks without hemodialysis). We identified no associations between several MPO genotypes and CKD. However, after multivariate adjustment, plasma MPO concentrations were positively correlated with CKD odds ratio (OR) = 5.87 (95 % confidence interval [CI]: 3.14-10.96). Significant additive interactions were observed between high plasma MPO concentrations and elevated blood cadmium (Cd) and lead (Pb) levels, and total urinary arsenic (As), or low plasma selenium (Se) concentrations, leading to increased ORs for CKD, with significant synergy indices recorded. High plasma MPO concentrations also showed multiplicative interactions with elevated blood Pb levels or low plasma Se concentrations, which increased the ORs for CKD (p-values = 0.005 and 0.009, respectively). Our study is the first to show a significant interaction between plasma MPO concentration and metals affecting the OR of CKD.

Acute kidney injury (AKI) and chronic kidney disease (CKD) represent two frequently observed clinical conditions. AKI is characterized by an abrupt decrease in glomerular filtration rate (GFR), generally associated with elevated serum creatinine (sCr), blood urea nitrogen (BUN), and electrolyte imbalances. This condition usually persists for approximately a week, causing a transient reduction in kidney function. If these abnormalities continue beyond 90 days, the condition is redefined as chronic kidney disease (CKD) or may advance to end-stage renal disease (ESRD). Recent research increasingly indicates that maladaptive repair mechanisms after AKI significantly contribute to the development of CKD. Thus, implementing early interventions to halt the progression from AKI to CKD has the potential to markedly improve patient outcomes. Although considerable research has been conducted, the exact mechanisms linking AKI to CKD are complex, and effective treatments remain limited. Kidney function is influenced by circadian rhythms, with the circadian gene Bmal1 being vital in managing these cycles. Recent research indicates that Bmal1 is significantly involved in the progression of both AKI and CKD. In this study, we conducted a retrospective analysis of Bmal1's role in AKI and CKD, reviewed recent research advancements, and investigated how Bmal1 influences the pathological mechanisms underlying the progression from AKI to CKD. Additionally, we highlighted gaps in the existing research and examined the potential of Bmal1 as a therapeutic target in kidney disease management. This work aims to provide meaningful insights for future studies on the role of the circadian gene Bmal1 in the transition from AKI to CKD, with the goal of identifying therapeutic approaches to mitigate kidney disease progression.

Acute kidney injury (AKI) is a condition that can result in changes in both urine production and creatinine levels in the bloodstream, complicating the treatment process and worsening outcomes for many hospitalized patients. BK polyomavirus (BKPyV), a member of the Polyomaviridae family, is prevalent in the population and remains latent in the body. It can reactivate in individuals with a compromised immune system, particularly post-kidney transplant, and can activate various transcription factors and immune mediators. Although reactivation is often asymptomatic, it can present as AKI, which is a risk factor for early loss of the transplanted organ. The immune response to BKPyV is crucial in controlling the virus and safeguarding organs from damage during infection. Understanding BKPyV pathways may offer novel opportunities for effectively treating BKPyV-associated complications. This review seeks to elucidate the potential mechanisms by which BKPyV reactivation can lead to AKI by analyzing various signaling pathways, as well as the identification of molecular mechanisms that BKPyV may utilize to induce AKI.

Chronic renal failure (CRF) is an incurable disease with unique challenges. Anemia is a frequent complication affecting dialysis patients. Erythropoietin (EPO) is used to treat anemia, but a poor response may result. We investigated genetic polymorphisms of store-operated calcium channel (SOC) signaling, an important erythropoietin-activated pathway that may induce EPO resistance in patients with renal failure. A total of 108 end stage renal disease (ESRD) patients were selected for this study. Patients were divided into two groups according to their erythropoietin resistance index (ERI): 39 patients with an ERI>10 and 69 patients with an ERI<10. We selected four tagging single nucleotide polymorphisms (tSNPs) in STIM1 and five in ORAI1 in our study. A polymerase chain reaction was performed, and genotyping against EPO resistance was correlated. Patients with the AG genotype of rs1561876 in STIM1, the TC genotype of rs6486795 in ORAI1, and the TG or GG genotypes of rs12320939 in ORAI1 were associated with an increased risk of erythropoietin resistance. Overall, we reported a moderately significant relationship between genetic polymorphisms of STIM1 and EPO resistance. We also reported a highly significant relationship between genetic polymorphisms of ORAI1 and EPO resistance. The (A-A-G) haplotype of STIM1 and the (G-T-G-T-A, G-C-G-C-G, or G-T-T-C-G) haplotypes of ORAI1 were significantly associated with EPO resistance.

Chronic kidney disease is characterised by the progressive loss of kidney function. However, predicting who will progress to kidney failure is difficult. Artificial Intelligence, including Machine Learning, shows promise in this area. This narrative review highlights the most common and important variables used in machine learning models to predict progressive chronic kidney disease. Ovid Medline and EMBASE were searched in August 2023 with keywords relating to 'chronic kidney disease', 'machine learning', and 'end-stage renal disease'. Studies were assessed against inclusion and exclusion criteria and excluded if variables inputted into machine learning models were not discussed. Data extraction focused on specific variables inputted into the machine learning models. After screening of 595 articles, 16 were included in the review. The most utilised machine learning models were random forest, support vector machines and XGBoost. The most commonly occurring variables were age, gender, measures of renal function, measures of proteinuria, and full blood examination. Only half of all studies included clinical variables in their models. The most important variables overall were measures of renal function, measures of proteinuria, age, full blood examination and serum albumin. Machine learning was consistently superior or non-inferior when compared to the Kidney Failure Risk Equation. This review identified key variables used in machine learning models to predict chronic kidney disease progression to kidney failure. These findings lay the foundations for the development of future machine learning models capable of rivalling the Kidney Failure Risk Equation in the provision of accurate kidney failure prediction.

Environmental exposure to arsenic (As), lead (Pb) and cadmium (Cd) may cause chronic kidney disease (CKD), with varying independent effects and unclear combined impact. This study aimed to evaluate these effects on CKD.

1,398 individuals were included. Urine arsenic (UAs) was determined by atomic fluorescence method. Urinary cadmium (UCd) and blood lead (BPb) levels were determined by graphite-furnace atomic absorption spectrometry. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2 or proteinuria. Generalized linear models (GLM), restricted cubic spline (RCS) models, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) models were employed to study the independent and combined effects of exposure to As, Pb and Cd on CKD risk.

Compared with non-CKD subjects, UAs, UCd, BPb, and creatinine adjusted urinary cadmium (UCdCr) were all significantly higher in CKD subjects. Compared with the lowest quartiles, the ORs (95%CIs) of CKD risk in the highest quartiles were 2.09 (1.16-3.74) for UAs, 2.84(1.56-5.18) for UCd, and 1.79 (1.05-3.06) for UCdCr, respectively. UAs, UCd, and UCdCr were all significantly positively associated with CKD risk in p-trend tests. RCS models revealed non-linear links between UAs, UCd, UCdCr and CKD risk, while a linear dose-response existed for BPb and CKD risk. The OR (95%CI) in WQS models were 1.72 (1.25-2.36) with UAs being the highest weighing metal(loid). BKMR models showed co-exposure mixture linked to higher CKD risk when the ln-transformed metal(loid)s above their 55th percentile. The ln-transformed UAs and UCdCr was significantly positively associated with CKD risk when the other two ln-transformed metals levels were all fixed at their different percentile levels. Synergism between Cd and Pb was also apparent.

Single As, and Cd exposure were positively associated with an increased CKD risk. Co-exposure to As, Pb and Cd was positively associated with CKD risk, with As playing a dominant role.

Young people living with HIV (YPLHIV) are at increased risk of developing chronic kidney disease (CKD) which is associated with high mortality and morbidity. Early diagnosis is important to halt progression. We aimed to estimate the prevalence and factors associated with CKD among YPLHIV in Kampala, Uganda, and to compare serum creatinine and cystatin C for early diagnosis of CKD in this population.

A cross-sectional study with YPLHIV aged 10 to 24 years was conducted in seven HIV clinics. Participants provided a urine and blood sample to measure urinary albumin, proteinuria, serum creatinine and cystatin C levels at baseline and after three months. The estimated glomerular filtration rate (eGFR) was calculated using CKDEPI 2021, Cockroft-Gault and bedside Schwartz equations using creatinine or cystatin C. The albumin creatinine ratio (ACR) and proteinuria were measured. CKD was defined as either eGFR < 60 ml/min/1.73m2 or < 90 ml/min/1.73m2 or ACR above 30 mg/g on two separate occasions. Univariable and multivariable logistic regression were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for factors associated with CKD.

A total of 500 participants were enrolled. Most were female (56%; n = 280) and aged 10 to 17 years (66.9%; n = 335). CKD prevalence ranged from 0 to 23% depending on the criteria, equation and biomarker used. Cystatin C-based equations estimated higher prevalence of CKD compared to creatinine-based ones. Prevalence of ACR above 30 mg/g was 10.1% and of proteinuria 29%. Factors independently associated with CKD were age (aOR = 1.42; 95% CI:1.30-1.51) and male sex (aOR = 3.02; 95% CI:1.68-5.43).

CKD prevalence among YPLHIV varied substantially depending on definitions used and the current definition would likely lead to missed cases of CKD among YPLHIV. Estimating equations should be validated against measured GFR in YPLHIV and the optimal definition of CKD in this vulnerable population should be revised to optimise detection and opportunities for reducing disease progression.

Not applicable.

Chronic kidney disease (CKD) involves numerous variables, but only a few significantly impact the classification task. The statistically equivalent signature (SES) method, inspired by constraint-based learning of Bayesian networks, is employed to identify essential features in CKD. Unlike conventional feature selection methods, which typically focus on a single set of features with the highest predictive potential, the SES method can identify multiple predictive feature subsets with similar performance. However, most feature selection (FS) classifiers perform suboptimally with strongly correlated data. The FS approach faces challenges in identifying crucial features and selecting the most effective classifier, particularly in high-dimensional data. This study proposes using the Least Absolute Shrinkage and Selection Operator (LASSO) in conjunction with the SES method for feature selection in CKD identification. Following this, an ensemble deep-learning model combining long short-term memory (LSTM) and gated recurrent unit (GRU) networks is proposed for CKD classification. The features selected by the hybrid feature selection method are fed into the ensemble deep-learning model. The model's performance is evaluated using accuracy, precision, recall, and F1 score metrics. The experimental results are compared with individual classifiers, including decision tree (DT), Random Forest (RF), logistic regression (LR), and support vector machine (SVM). The findings indicate a 2% improvement in classification accuracy when using the proposed hybrid feature selection method combined with the LSTM and GRU ensemble deep-learning model. Further analysis reveals that certain features, such as HEMO, POT, bacteria, and coronary artery disease, contribute minimally to the classification task. Future research could explore additional feature selection methods, including dynamic feature selection that adapts to evolving datasets and incorporates clinical knowledge to enhance CKD classification accuracy further.

The global burden of kidney disease is increasing, paralleled by a rising number of natural and man-made crises. During these tumultuous times, accessing vital health care resources becomes challenging, posing significant risks to individuals, particularly those with kidney disease. This review delves into the impact of crises on kidney disease, with a particular focus on acute kidney injury (AKI), kidney failure, and kidney transplant. Patients experiencing crush injuries leading to AKI may encounter delayed diagnosis due to the chaotic nature of disasters and limited availability of resources. In chronic crises such as conflicts, patients with kidney failure are particularly affected, and deviations from dialysis standards are unfortunately common, impacting morbidity and mortality rates. Additionally, crises also disrupt access to kidney transplants, potentially compromising transplant outcomes. This review underscores the critical importance of preparedness measures and proactive management for kidney disease in crisis settings. Collaborative efforts among government bodies, rescue teams, health care providers, humanitarian agencies, and nongovernmental organizations are imperative to ensure equitable and reasonable care for kidney disease patients during times of crises, with the aim of saving lives and improving outcomes.

Kidney replacement therapy (KRT) by dialysis or kidney transplantation represents the main treatment modalities for patients with kidney failure. Here we evaluate the trends in taking care of such patients in North Macedonia from 2015 through 2020.

The patients were analyzed according to age, sex, primary disease, and treatment modality. They were further subdivided into 3 groups: Group 1, prevalent patients; Group 2, incident patients with analysis starting at day 1 of KRT; and Group 3, incident patients with analysis starting at day 91 of KRT.

The study included 10,395 person-years, mean age 59.2 ± 9.5 years, male sex 60.2%, hemodialysis therapy 84.7% in 2015 and 85.9% in 2020. Hypertension and diabetes mellitus were the leading causes of kidney disease. Group 1 showed an increase in KRT care of 10.3% (from 799 part per million population [pmp] in 2015 to 881 pmp in 2020). In Group 2 the number of patients was increasing with each successive year, the highest growth being observed in 2019. The patients of Group 3 showed a significant growth during this time period, from 126.5 ppm in 2015 to 162 pmp in 2019, but a subsequent decrease of 16.4% in 2020 (135.5 pmp), probably explained by the SARS-CoV-2 pandemic.

In the analyzed period, an increase in the number of patients with kidney failure in need of KRT is observed. We believe that this trend will continue in the following years, which should be taken into account when planning health policies in our country in the future.

This study explores the intricate relationship between Chronic Kidney Disease (CKD), the Triglyceride-Glucose (TyG) index, and Cardiovascular Disease (CVD) in a U.S. adult population. It focuses on understanding how the TyG index, as a marker of insulin resistance, relates to cardiovascular risk in the presence of CKD.

A cross-sectional analysis was conducted using data from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. The study involved classifying stages of CKD, calculating the TyG index, and applying statistical analyses including logistic regression.

The investigation revealed that individuals with CKD, who comprised 49% males with an average age of 47 years, exhibited a higher incidence of CVD. The study demonstrated that before adjusting for the TyG index, the odds ratio (OR) for the association between CKD and CVD was 1.77. Importantly, the TyG index was found to mediate 10% of the association between CKD and CVD. Moreover, a significant synergistic interaction was observed between a high TyG index and CKD, with the combined presence of these conditions increasing the risk ratio for CVD to 3.01.

The findings highlight the crucial role of insulin resistance in the link between CKD and CVD. The paper discusses the implications of chronic inflammation and endothelial dysfunction in CKD patients and the importance of the TyG index in assessing cardiovascular risk.

The colliding epidemic of infectious and non-communicable diseases in South Africa could potentially increase the prevalence of kidney disease in the country. This study determines the prevalence of kidney damage and known risk factors in a rural community of the Eastern Cape province, South Africa.

This observational cross-sectional study was conducted in the outpatient department of the Mbekweni Community Health Centre in the Eastern Cape between May and July 2022. Relevant data on demography, medical history, anthropometry and blood pressure were obtained. The glomerular filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration Creatinine (CKD-EPICreatinine) equation and the re-expressed four-variable Modification of Diet in Renal Disease (MDRD) equation, without any adjustment for black ethnicity. Prevalence of kidney damage was defined as the proportion of individuals with low eGFR (<60mL/min per 1.73m2). The presence of proteins in the spot urine samples was determined with the use of test strips. We used the logistic regression model analysis to identify the independent risk factors for significant kidney damage.

The mean (±standard deviation) age of the 389 participants was 52.3 (± 17.5) years, with 69.9% female. The prevalence of significant kidney damage was 17.2% (n = 67), as estimated by the CKD-EPICreatinine, with a slight difference by the MDRD equation (n = 69; 17.7%), while the prevalence of proteinuria was 7.2%. Older age was identified as a significant risk factor for CKD, with an odds ratio (OR) = 1.08 (95% confidence interval [CI]: 1.06-1.1, p < 0.001). Hypertension was strongly associated with proteinuria (OR = 4.17, 95% CI 1.67-10.4, p<0.001).

This study found a high prevalence of kidney damage (17.2%) and proteinuria (7.97%) in this rural community, largely attributed to advanced age and hypertension, respectively. Early detection of proteinuria and decreased renal function at community health centres should trigger a referral to a higher level of care for further management of patients.

Young people living with HIV (YPLHIV) are at increased risk of developing chronic kidney disease (CKD) which is associated with high mortality and morbidity. Early diagnosis is important to halt progression. We aimed to estimate the prevalence and factors associated with CKD among YPLHIV in Kampala, Uganda, and to compare serum creatinine and cystatin C for early diagnosis of CKD in this population.

A cross-sectional study with YPLHIV aged 10 to 24 years was conducted in seven HIV clinics. Participants provided a urine and blood sample to measure urinary albumin, proteinuria, serum creatinine and cystatin C levels at baseline and after three months. The estimated glomerular filtration rate (eGFR) was calculated using CKDEPI 2021, Cockroft-Gault and bedside Schwartz equations using creatinine or cystatin C. The albumin creatinine ratio (ACR) and proteinuria were measured. CKD was defined as either eGFR <60ml/min/1.73m2 or <90ml/min/1.73m2 or ACR above 30mg/g on two separate occasions. Univariable and multivariable logistic regression were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for factors associated with CKD.

A total of 500 participants were enrolled. Most were female (56%; n=280) and aged 10 to 17 years (66.9%; n=335). CKD prevalence ranged from 0-23% depending on the criteria, equation and biomarker used. Cystatin C-based equations estimated higher prevalence of CKD compared to creatinine-based ones. Prevalence of ACR above 30mg/g was 10.1% and of proteinuria 29%. Factors independently associated with CKD were age (aOR=1.42; 95% CI:1.30-1.51) and male sex (aOR=3.02; 95% CI:1.68-5.43).

CKD prevalence among YPLHIV varied substantially depending on definitions used and the current definition would likely lead to missed cases of CKD among YPLHIV. Estimating equations should be validated against measured GFR in YPLHIV and the optimal definition of CKD in this vulnerable population should be revised to optimise detection and opportunities for reducing disease progression.

The burden of chronic kidney disease (CKD) and its risk factors are projected to rise in parallel with the rapidly ageing global population. By 2050, the prevalence of CKD category G3-G5 may exceed 10% in some regions, resulting in substantial health and economic burdens that will disproportionately affect lower-income countries. The extent to which the CKD epidemic can be mitigated depends largely on the uptake of prevention efforts to address modifiable risk factors, the implementation of cost-effective screening programmes for early detection of CKD in high-risk individuals and widespread access and affordability of new-generation kidney-protective drugs to prevent the development and delay the progression of CKD. Older patients require a multidisciplinary integrated approach to manage their multimorbidity, polypharmacy, high rates of adverse outcomes, mental health, fatigue and other age-related symptoms. In those who progress to kidney failure, comprehensive conservative management should be offered as a viable option during the shared decision-making process to collaboratively determine a treatment approach that respects the values and wishes of the patient. Interventions that maintain or improve quality of life, including pain management and palliative care services when appropriate, should also be made available.

Introduction: Chronic kidney disease (CKD) is associated with metabolic disorders. However, the evidence for the causality of circulating metabolites to promote or prevent CKD is still lacking. Methods: The two-sample Mendelian randomization (MR) analysis was conducted to evaluate the latent causal relationship between the genetically proxied 486 blood metabolites and CKD. Genome-wide association study (GWAS) data for exposures were derived from 7824 European GWAS on metabolite levels, which have been extensively utilized in the medical field to elucidate the mechanisms underlying disease onset and progression. The random inverse variance weighted (IVW) is the primary analysis for causality analysis while MR-Egger and weighted median as complementary analyses. For the further identification of metabolites, reverse MR and linkage disequilibrium score regression were performed for further evaluation. The drug target for N-acetylornithine was subsequently supplemented into the analysis, with MR and colocalization analysis being utilized. Key metabolic pathways were identified via MetaboAnalyst 4.0 (https://www.metaboanalyst.ca/) online website. Results: N-acetylornithine was identified as a reliable metabolite that increases the susceptibility to estimated glomerular filtration rate (eGFR) decrease (β = 0.047; 95% confidence interval: -0.068 to -0.026; PIVW = 1.5E-5). The "glyoxylate and dicarboxylate metabolism" pathway showed significant relevance to CKD development (P = 6E-4), whereas the "glycine, serine, and threonine metabolism" pathway was also recognized as associated with CKD by general practitioners (P = 7E-4). Colocalization analysis revealed a robust genetic link between N-acetylornithine and both CKD and eGFR, with 85.1% and 99.4% colocalization rates, respectively. IVW-MR analysis substantiated these findings with a significant positive association for CKD (odds ratio = 1.43, P = 4.7E-5) and a negative correlation with eGFR (b = -0.04, P = 1.13E-31). Conclusions: MR was utilized to explore the potential causal links between 61 genetic serum metabolites and CKD. N-acetylornithine and NAT8 were further explored as a potential therapeutic target for CKD treatment.

In resource-constrained countries, inadequate access to healthcare and prognostic tools can be the Achilles' heel in effectively managing chronic kidney disease (CKD). There is a significant similarity in the pathogenesis of CKD and liver fibrosis. The role of liver fibrosis (LF) scores in predicting short-term clinical outcomes in hospitalized patients with CKD is unknown. Our study aimed at calculating LF scores and studying the association of liver fibrosis with short-term mortality and morbidity in CKD patients.

Patients aged above 15 years diagnosed with CKD as per the KDIGO criteria were enrolled. LF scores, namely, NFS, GPRI, and FIB-4 scores were calculated. Patients were followed up for a period of 28 days for good and poor composite outcomes, namely, the requirement of hemodialysis, non-invasive ventilation, prolonged hospital stay, and neurological and cardiovascular outcomes including death.

Among 163 patients, 70.5% were below 60 years of age, 82.2% were male and 35% were diabetic. At 28-day follow up, 52.1% had poor composite outcome. The AUROC for GPRI and FIB-4 in predicting poor outcomes was 0.783 (95% CI: 0.71-0.855) (p < 0.001) and 0.62 (95% CI: 0.534-0.706) (p = 0.008), respectively. The AUROC for GPRI and NFS in predicting all-cause mortality was 0.735 (95% CI: 0.627-0.843) (p = 0.001) and 0.876 (95% CI, 0.8-0.952) (p < 0.001), respectively.

We found a positive association between LF scores and CKD outcomes in hospitalized patients. The LF scores significantly predicted poor outcomes in patients with CKD. Among the scores, GPRI was found to be a stronger predictor in predicting outcomes in both diabetic and non-diabetic patients with CKD. A high GPRI score was also associated with poor outcomes and increased mortality in both diabetics and non-diabetics.

Cardiovascular pathology is the main cause of death in chronic kidney disease (CKD) patients. CKD is associated with the accumulation of uremic toxins in the bloodstream, and indoxyl sulfate (IS) is one of the most abundant uremic toxins found in the blood of CKD patients. We conducted an in vitro study to assess the mechanisms underlying the IS-induced endothelial dysfunction that could lead to cardiovascular diseases. We also studied their extracellular vesicles (EVs) owing to their capacity to act as messengers that transmit signals through their cargo.

EVs were characterized by nanoparticle tracking analysis, transmission electron microscopy, flow cytometry, and tetraspanin expression. Cell lysates and isolated EVs were analyzed using liquid chromatography coupled with mass spectrometry, followed by Gene Set Enrichment Analysis to identify the altered pathways.

Proteomic analysis of endothelial cells revealed that IS causes an increase in proteins related to adipogenesis, inflammation, and xenobiotic metabolism and a decrease in proliferation. Extracellular matrix elements, as well as proteins associated with myogenesis, response to UV irradiation, and inflammation, were found to be downregulated in IS-treated EVs. Fatty acid metabolism was also found to be increased along with adipogenesis and inflammation observed in cells.

The treatment of endothelial cells with IS increased the expression of proteins related to adipogenesis, inflammation, and xenobiotic metabolism and was less associated with proliferation. Furthermore, EVs from cells treated with IS may mediate endothelial dysfunction, since they present fewer extracellular matrix elements, myogenesis, inflammatory factors, and proteins downregulated in response to UV radiation.

To characterize the incidence of kidney failure associated with intravitreal anti-VEGF exposure; and compare the risk of kidney failure in patients treated with ranibizumab, aflibercept, or bevacizumab.

Retrospective cohort study across 12 databases in the Observational Health Data Sciences and Informatics (OHDSI) network.

Subjects aged ≥ 18 years with ≥ 3 monthly intravitreal anti-VEGF medications for a blinding disease (diabetic retinopathy, diabetic macular edema, exudative age-related macular degeneration, or retinal vein occlusion).

The standardized incidence proportions and rates of kidney failure while on treatment with anti-VEGF were calculated. For each comparison (e.g., aflibercept versus ranibizumab), patients from each group were matched 1:1 using propensity scores. Cox proportional hazards models were used to estimate the risk of kidney failure while on treatment. A random effects meta-analysis was performed to combine each database's hazard ratio (HR) estimate into a single network-wide estimate.

Incidence of kidney failure while on anti-VEGF treatment, and time from cohort entry to kidney failure.

Of the 6.1 million patients with blinding diseases, 37 189 who received ranibizumab, 39 447 aflibercept, and 163 611 bevacizumab were included; the total treatment exposure time was 161 724 person-years. The average standardized incidence proportion of kidney failure was 678 per 100 000 persons (range, 0-2389), and incidence rate 742 per 100 000 person-years (range, 0-2661). The meta-analysis HR of kidney failure comparing aflibercept with ranibizumab was 1.01 (95% confidence interval [CI], 0.70-1.47; P = 0.45), ranibizumab with bevacizumab 0.95 (95% CI, 0.68-1.32; P = 0.62), and aflibercept with bevacizumab 0.95 (95% CI, 0.65-1.39; P = 0.60).

There was no substantially different relative risk of kidney failure between those who received ranibizumab, bevacizumab, or aflibercept. Practicing ophthalmologists and nephrologists should be aware of the risk of kidney failure among patients receiving intravitreal anti-VEGF medications and that there is little empirical evidence to preferentially choose among the specific intravitreal anti-VEGF agents.

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

The 2007 Screening for Occult Renal Disease (SCORED) questionnaire accesses risk factors for chronic kidney disease (CKD) and makes it possible to screen high-risk patients, being adapted and validated for the Brazilian culture in 2012. The present study evaluated the questionnaire's ability to predict the occurrence of CKD in asymptomatic patients, as well as identify a high risk for developing the disease.

This was an analytical observational study with a cross-sectional design carried out in two stages: answering the SCORED and performing fasting blood glucose and creatinine tests. The participants were patients at the Hospital das Clínicas of the Federal University of Minas Gerais (HC-UFMG) with scheduled creatinine and fasting blood glucose tests, respecting the inclusion and exclusion criteria defined for the study. SCORED was applied with questions covering gender, age, proteinuria, and diabetes, being classified as high or low risk for CKD. The data collected were height, weight, age, sex, diagnosis of diabetes mellitus, and fasting blood glucose.

The sample space was 212 individuals, the majority of whom were female (N=130, 61.3%), with a median of 58 years of age. The prevalence of CKD was 15.6% (N=33) with a sensitivity of 90.9%, a specificity of 30.2%, a positive predictive value of 19.4%, a negative predictive value of 94.7%, and a diagnostic accuracy of 39.7%.

We concluded that the SCORED questionnaire can be a useful tool for screening CKD in asymptomatic patients and also that there is a relationship was detected between glycemic changes and an increased risk for CKD.

Liquid smoke is a food additive and cresols are among its chemical constituents, potentially toxic to human health. Thus, the objective of this study was to develop a method to quantify cresols in liquid smoke. First, the liquid-liquid extraction with low temperature purification (LLE-LTP) was validated for cresols in water, as there are no cresol-free liquid smoke samples. Analyzes were performed by gas chromatography coupled to mass spectrometry in full scan mode. LLE-LTP was subsequently applied in five commercial samples of liquid smoke. Validation results showed that the proposed extraction method was selective for cresols, linear in the range of 0.5 to 35 mg L-1, limit of quantification of 0.5 mg L-1, recovery rate between 90% and 104% and relative standard deviation lower than 10%. The quantification of cresols in liquid smoke samples ranged from 3.0 to 38.3 mg L-1 and the concentration of these chemical contaminants in liquid smoke remained constant for at least 21 days at 25 °C.

Renal fibrosis is the result of all chronic kidney diseases and is becoming a major global health hazard. Currently, traditional treatments for renal fibrosis are difficult to meet clinical needs due to shortcomings such as poor efficacy or highly toxic side effects. Therefore, therapeutic strategies that target the kidneys are needed to overcome these shortcomings. Drug delivery can be attained by improving drug stability and addressing controlled release and targeted delivery of drugs in the delivery category. By combining drug delivery technology with nanosystems, controlled drug release and biodistribution can be achieved, enhancing therapeutic efficacy and reducing toxic cross-wise effects. This review discusses nanomaterial drug delivery strategies reported in recent years. Firstly, the present review describes the mechanisms of renal fibrosis and anti-renal fibrosis drug delivery. Secondly, different nanomaterial drug delivery strategies for the treatment of renal injury and fibrosis are highlighted. Finally, the limitations of these strategies are also discussed. Investigating various anti-renal fibrosis drug delivery strategies reveals the characteristics and therapeutic effects of various novel nanosystem-derived drug delivery approaches. This will serve as a reference for future research on drug delivery strategies for renal fibrosis treatment.

Niacin is reported to decrease phosphorus concentration in maintenance hemodialysis (MHD) patients. Egg white is one of the main substitutable proteins in MHD patients due to its low phosphorus content. Therefore, we aimed to evaluate the effects of combined egg white and niacin supplementation on dialysis patients' serum phosphorus and nutritional biomarkers.

In this randomized controlled clinical trial, 98 patients on MHD were randomly allocated to four groups for 8 weeks: 24 g egg white (n = 25), 600 g niacin daily (n = 24), egg white combined with niacin (n = 24), and control (n = 24). Calcium, phosphorus, fibroblast growth factor-23, and other nutritional markers were assessed.

There was a significant difference among the groups only in phosphorus at the end of the trial, which was significantly lower in the niacin group (4.38 + 0.812 mg/dL) than in both the egg white (5.07 + 0.49 mg/dL) and egg white with niacin supplementation (5.41 + 0.662 mg/dL) groups. In this regard, albumin increased in egg white and egg white with niacin supplementation, while albumin did not change significantly in the niacin group. Urea reduction ratio and Kt/V rose only in the egg-white group, while aspartate aminotransferase increased only in the niacin and control groups.

Niacin decreases serum phosphorus concentration more than egg-white protein or a combined intervention. Egg white protein supplementation has beneficial effects on some nutritional statuses other than phosphorus control without the side effects of niacin.