Exercise benefits patients on maintenance hemodialysis (MHD) by addressing complications and dysfunctions. Elastic band exercise is cost-effective, but its safety, efficacy, and feasibility during dialysis are not well-established. The aim of this study is to investigate the physical and mental effects of intradialytic elastic band exercise in patients on MHD. Sixty patients on MHD were randomly assigned to the exercise or control group (30 patients/group). The control group received routine hemodialysis care, whereas those in the exercise group performed intradialytic elastic band exercises for 0.5-2 h during hemodialysis three times a week for 12 weeks. Physical function (Short Physical Performance Battery [SPPB]), cognitive function (Montreal Cognitive Assessment [MoCA]), fatigue (14-item Fatigue Scale [FS-14]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), and anxiety and depression (Hamilton Anxiety Rating Scale [HAMA]/Hamilton Depression Rating Scale [HAMD]) were assessed. The exercise group showed significant improvements in SPPB (p = 0.008) and MoCA (p < 0.001) scores compared to pre-intervention and control groups. FS-14 scores decreased significantly (p = 0.005). PSQI (p < 0.001) and HAMA (p < 0.001) scores improved post-intervention but not versus control. HAMD scores reduced significantly (p < 0.001). Satisfaction and recommendation scores were 9.57 and 9.71. In conclusions, intradialytic elastic band exercise improved physical and cognitive function and alleviated fatigue, sleep issues, depression, and anxiety in patients on MHD. With high compliance, no significant adverse events, and high patient satisfaction, it is recommended as a routine intervention during dialysis.

This cross-sectional analysis from the CZecking Heart Failure in patients with advanced Chronic Kidney Disease trial (ISRCTN18275480) examined pulmonary hypertension and right ventricular-pulmonary arterial coupling in patients on chronic hemodialysis. The aims of this analysis were: 1. To analyze relations between pulmonary hypertension and right ventricular-pulmonary arterial coupling with dialysis access flow and current hydration; 2. To analyze structural heart changes associated with right ventricular-pulmonary arterial uncoupling; 3. To reveal the prevalence, etiology and severity of pulmonary hypertension in the Czech hemodialysis population.

We performed expert echocardiography, vascular access flow measurements, bioimpedance analysis, and laboratory testing in 336 hemodialysis patients.

Pulmonary hypertension was present in 34% (114/336) patients and right ventricular-pulmonary arterial uncoupling was present in 25% of patients with pulmonary hypertension. Only weak associations between the flow of the dialysis arteriovenous access and estimated pulmonary arterial systolic pressure and right ventricular-pulmonary arterial coupling was proved. There was a strong association between hydration status assessed by estimated central venous pressure with pulmonary arterial systolic pressure (Rho 0.6, p < 0.0001) and right ventricular-pulmonary arterial coupling (Rho -0.52, p < 0.0001) and association between overhydration to extracellular water ratio with pulmonary arterial systolic pressure (Rho 0.31, p = 0.0001) and right ventricular-pulmonary arterial coupling (Rho -0.29, p = 0.002). The prevalence of heart failure was significantly higher in patients with right ventricular-pulmonary arterial uncoupling (88% vs. 52%, p = 0.0003).

These findings suggest that optimizing volume status and treating heart failure should be prioritized in hemodialysis patients to prevent pulmonary hypertension progression and right ventricular-pulmonary arterial uncoupling.

This study aims to evaluate the impact of COVID-19 on the progression of CKD in non-dialysis patients and its relation to clinical outcomes in Palestine.

We conducted a retrospective cohort study that followed non-dialysis CKD patients receiving treatment at outpatient clinics in governmental hospitals. Out of the 248 CKD patients who met the inclusion criteria, 98 were diagnosed with COVID-19 between March 2020 and March 2022. We collected data at three distinct time intervals, both prior to and after their COVID-19 infection. We examined the decline in eGFR and gathered demographic information, hospitalization, and mortality rates. The drop in eGFR was recorded 15 months from baseline.

The mean age of the patients was 55 years, with 55.6% being male. Patients diagnosed with COVID-19 faced a significantly higher risk of rapid deterioration in eGFR, with a 3.7-fold increase compared to those without COVID-19 (ap-value: <0.001; aOR: 3.7; 95% CI: 2.1-6.3). Additionally, COVID-19 patients had 4.4 times higher mortality rates (ap-value: 0.005; aOR: 4.4; 95% CI: 1.6-12.4), 13.3 times higher rates of dialysis initiation within 15 months post-baseline (ap-value: <0.001; aOR: 13.3; 95% CI: 6.1-28.7), and 3.5 times higher rates of hospital admissions (ap-value: <0.001; aOR: 3.5; 95% CI: 1.8-6.7) compared to the COVID-19 negative group.

CKD patients who contract COVID-19 experience a more rapid decline in kidney function, leading to worse health outcomes, including increased mortality rates, a greater need for dialysis, and higher hospitalization rates.

Dyslipidemia and inflammation often coexist in the progression of kidney failure, with the atherosclerosis index of plasma (AIP) serving as a valuable marker for monitoring dyslipidemia. This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES) spanning 2005 to 2018, involving a total of 10,358 participants. AIP was calculated as the logarithmic ratio (base 10) of triglycerides to high-density lipoprotein cholesterol (log10[TG/HDL-C]), while kidney failure was assessed through self-reported physician diagnosis. Logistic regression models and restricted cubic splines (RCS) were utilized to examine the association between AIP and the risk of kidney failure, with additional subgroup analyses performed to explore potential interactions. Mediation analyses were conducted to investigate whether inflammatory markers mediated the relationship between AIP and kidney failure. In logistic regression, after adjusting for all covariates, AIP was found to be positively associated with the risk of kidney failure [OR = 1.74 (95% CI: 1.04-2.92)], and a linear relationship between AIP and kidney failure risk was observed (P-non-linear = 0.4050). Mediation analysis revealed that segmented neutrophils, eosinophils, and monocytes partially mediated the association between AIP and kidney failure, with mediation proportions of 19.65%, 2.44%, and 7.25%, respectively. These findings suggest that Higher AIP was associated with an increased risk of kidney failure, with segmented neutrophils, eosinophils, and monocytes serving as partial mediators. The results provide valuable insights into the role of inflammation in kidney failure and highlight potential avenues for its prevention.

Chronic kidney disease (CKD) prognosis is closely tied to the interplay between nutrition and inflammation. However, comprehensive nutritional-inflammatory indices for prognostic evaluation are rare in CKD. This study explored the association of the advanced lung cancer inflammation index (ALI) with estimated glomerular filtration rate (eGFR) and all-cause mortality in CKD patients.

A total of 1,982 CKD patients from the National Health and Nutrition Examination Survey (NHANES) database (2011-2018) were included in the analysis. Analytical methods included linear regression, cox regression, and restricted cubic spline (RCS) analysis. Subgroup and sensitivity analyses were performed, and further evaluation was conducted using the receiver operating characteristic (ROC) curve and C-index for all-cause mortality across different CKD stages.

Among CKD patients, 1,103 patients (55.7%) were classified as stage I-II, and 879 patients (44.3%) as stage III-V. After adjusting covariates, ALI was found to be positively correlated with eGFR (Beta = 0.11; 95% CI: 0.07-0.15), and negatively related with all-cause mortality (HR = 0.72; 95% CI: 0.63-0.83). Subgroup analysis showed that the positive correlation between ALI and eGFR was stronger in CKD stage III-V compared to stage I-II. However, ALI's protective effect on mortality was weaker in stage III-V. The C-index for ALI was 0.648 in stage I-II and 0.660 in stage III-V.

ALI was significantly associated with eGFR and all-cause mortality in CKD patients. Nutritional and anti-inflammatory interventions in early-stage CKD may improve prognosis, and ALI may have great potential as a multifaceted biomarker to influence the prognosis of CKD, particularly in stages III-V.

Kidney diseases are among the most prevalent conditions worldwide, impacting over 850 million individuals. They are categorized into acute kidney injury and chronic kidney disease. Current preclinical and clinical trials have demonstrated that endothelin (ET) is linked to the onset and progression of kidney disease. In kidney diseases, pathological conditions such as hyperglycemia, acidosis, insulin resistance, and elevated angiotensin II levels lead to an increase in ET. This elevation activates endothelin receptor type A, resulting in harmful effects like proteinuria and a reduced glomerular filtration rate (GFR). Therefore, to slow the progression of kidney disease, endothelin receptor antagonists (ERAs) have been proposed as promising new therapies. Numerous studies have demonstrated the efficacy of ERAs in significantly reducing proteinuria and improving GFR, thereby slowing the progression of kidney diseases. This review discusses the mechanisms of action of ERAs in treating kidney disease, their efficacy and safety in preclinical and clinical studies, and explores future prospects for ERAs.

Kidney fibrosis is a key pathological feature in the progression of chronic kidney disease (CKD), traditionally diagnosed through invasive kidney biopsy. This study aimed to develop and validate a noninvasive, multi-center predictive model incorporating machine learning (ML) for assessing kidney fibrosis severity using biochemical markers.

This multi-center retrospective study included 598 patients with kidney fibrosis from four hospitals. A training cohort of 360 patients from Shanghai Tongji Hospital was used to develop a predictive nomogram and ML model, with fibrosis severity classified as mild or moderate-to-severe based on Banff scores. Logistic regression identified key predictors, which were incorporated into a nomogram and ML model. An external validation cohort of 238 patients from three additional hospitals was used for model evaluation.

Serum creatinine (Scr), estimated glomerular filtration rate (eGFR), parathyroid hormone (PTH), brain natriuretic peptide (BNP), and sex were identified as independent predictors of kidney fibrosis severity. The nomogram demonstrated superior discriminative ability in the training cohort (AUC: 0.89, 95% CI: 0.85-0.92) compared to eGFR (AUC: 0.83, 95% CI: 0.78-0.87) and Scr (AUC: 0.87, 95% CI: 0.83-0.91). Among ML models, the Random Forest (RF) model achieved the highest AUC (0.98). In external validation, the nomogram and RF models maintained robust performance with AUCs of 0.86 and 0.79, respectively.

This study presents a validated, noninvasive, multi-center Scr-based machine learning model for assessing kidney fibrosis severity in CKD. The integration of a clinical nomogram and ML approach offers a novel, practical alternative to biopsy for dynamic fibrosis evaluation.

Cardiovascular complications remain a leading cause of mortality in patients with end-stage kidney disease undergoing dialysis. This study aimed to evaluate differences in left atrial (LA) structure and function between hemodialysis and peritoneal dialysis patients using four-dimensional automatic left atrial quantification (4D Auto LAQ) technology.

This study included 125 patients with end-stage kidney disease, categorized into hemodialysis (n = 69) and peritoneal dialysis (n = 56) groups. Conventional echocardiography and 4D Auto LAQ were used to assess LA volume and strain parameters. Differences between groups were analyzed.

Hemodialysis patients exhibited significantly larger LA minimum volume, maximum volume, pre-atrial contraction volume, and maximum volume index compared to peritoneal dialysis patients (p < 0.05). Conversely, hemodialysis patients had significantly lower LA reservoir circumferential strain (LASr-c) and conduit circumferential strain (LAScd-c) than peritoneal dialysis patients (p < 0.05). LA ejection fraction (LAEF) correlated positively with LASr-c (r = 0.809). Multivariate regression analysis identified LASr-c as independently associated with dialysis modality and LAEF. Sensitivity analysis confirmed LAEF as an independent determinant of LASr-c.

Hemodialysis is associated with increased LA volume and impaired LA function compared to peritoneal dialysis. These findings highlight the importance of LA monitoring in dialysis patients to identify early cardiac dysfunction.

Patients with chronic kidney disease are at high and very high risk of cardiovascular disease. As estimated glomerular filtration rate declines, the incidence and severity of risk factors, complications, and atherosclerotic cardiovascular events increase. In this scenario, tailored assessment is the key to evaluate the severity of chronic kidney disease and estimate cardiovascular disease risk. Personalized stratification differentiates patients with chronic kidney disease without diabetes mellitus or established atherosclerotic cardiovascular disease in their management and beneficial treatment. Exercise intensity assessment and prescription is suggested to propose specific and safe recommendations for physical activity, training, and cardiac rehabilitation. Programs are based on a combination of endurance and resistance exercise and should be adapted to very high risk chronic kidney disease and haemodialysis patients and after kidney transplantation. Appropriate management of cardiovascular complications in these patients, such as risk factors, heart failure, arrhythmias, and coronary artery disease, is essential to ensure the best treatment and improve the prognosis. Therefore, we propose a critical and comprehensive review to suggest how to manage patients with chronic kidney disease in clinical practice and, specifically, with regard to cardiovascular risk assessment, exercise training prescription, and management of complications.

Chronic Kidney Disease of unknown aetiology (CKDu) is an emerging global health issue, yet research on risk factors is limited. This study addresses the gap by developing, validating, and evaluating the reliability of a questionnaire to assess the risk factors of CKDu.

A draft version of the questionnaire was prepared based on thorough literature review and experts' discussion. Six experts validated it for content validity, incorporating items with an item level content validity index ≥ 0.78. The reliability of the developed questionnaire was assessed using the test-retest method. Sample size for reliability was calculated using a tool by ArifinWN; 2018. Subjects were recruited by purposive sampling after obtaining informed consent. Data were analysed for reliability using Statistical-Package for the Social-Sciences (SPSS) version 20.0.

A 10-domain questionnaire was developed to assess CKDu risk factors. Six experts, comprised of three associate professors, two nephrologists and one renal pharmacist, validated the questionnaire. All items had an item level content validity index > 0.78, and the scale level content validity index of the questionnaire was 0.98. The questionnaire was administered to 165 subjects with a mean age of 50.65 ± 12.5 years, comprising 53.9% males. Most of them were labourers (38.2%) followed by farmers (21.8%). Among the risk factors, 57% of subjects were exposed to long hours of sunlight during work, 52.7% burned garbage waste and 46.1% were exposed to insecticides and pesticides. The questionnaire was re-administered after two weeks for reliability. All items under each domain fulfilled the minimum internal consistency of > 0.7.

The questionnaire demonstrated its validity and reliability in assessing the risk factors of CKDu among the subjects.

Long non-coding RNA(LncRNA) has been reported to be associated with intestinal barrier damage. The aim of this study was to explore the mechanism of lncRNA Nuclear enriched abundant transcript 1 (NEAT1) in uremic toxin-induced intestinal epithelial barrier injury.

Human colon cancer cells (Caco-2) were used to establish intestinal epithelial injury models with the urea treatment in different conditions. Cell Counting Kit-8 (CCK-8) and Western blot screening the best concentration and time. The expressions of lncRNA NEAT1 and miR-122-5p were measured by quantitative real-time polymerase chain reaction (qRT-PCR). Western blot and immunofluorescence were used to detect the expression of tight junction proteins Occludin, ZO-1 and Claudin-1. Sodium fluorescein was used to detect the paracellular permeability of intestinal epithelial injury models. The binding of miR-122-5p to lncRNA NEAT1 and Occludin was determined by bioinformatics analysis and dual luciferase reporter assay.

The best condition for the injury model was urea treatment in 144 mg/dl for 48 hours. With the increase of urea intervention time and concentration, the damage degree of intestinal epithelial cells is aggravated. Based on the qRT-PCR results, lncRNA NEAT1 was significantly down-regulated in the model group. Meanwhile, the tight junction proteins Occludin, ZO-1 and Claudin-1 were significantly reduced. The permeability of sodium fluorescein was significantly increased in the model group. Overexpression of lncRNA NEAT1 can alleviate the above performances. As the target gene of lncRNA NEAT1, miR-122-5p is significantly up-regulated in the model group. The dual luciferase reporter assay proved that miR-122-5p was targets to Occludin. The protective effect of overexpression lncRNA NEAT1 on intestinal epithelial barrier function is reversed by miR-122-5p mimics.

LncRNA NEAT1 protects uremic toxin-induced intestinal epithelial barrier injury by regulating miR-122-5p/Occludin axis.

Chronic kidney disease (CKD) is characterized by progressive loss of kidney function and irreversible structural changes. Both kidney donation and amikacin exhibit nephrotoxic effects; however, polyphenols like resveratrol are known for their nephroprotective properties due to antioxidant capabilities. This study investigates the protective effects of resveratrol in a renal injury model involving unilateral nephrectomy and amikacin in Wistar rats. Male Wistar rats (n = 25) were divided into following five groups: (1) vehicle control, (2) resveratrol control, (3) kidney damage (unilateral nephrectomy plus amikacin), (4) resveratrol post-treatment, and (5) resveratrol pre-treatment. Renal function was assessed through serum creatinine and urea measurements. Oxidative stress was evaluated via malondialdehyde (MDA) levels, while antioxidant status was determined through total antioxidant capacity (TAC). Tissue analysis employed H&E, PAS, and Van Giesons trichrome staining. Data analysis was conducted using ANOVA and Tukeys post-hoc test for parametric data and the Kruskal-Wallis test with Dunns post-hoc for non-parametric data, with significance set at p < 0.05. Resveratrol treatment significantly improved body weight, renal compensatory growth, and several biochemical parameters. These results indicate that resveratrol may represent a promising nutritional strategy for safeguarding kidney function and architecture in renal injury contexts.

Platinum-based chemotherapies are essential in the treatment of several malignancies. However, such medications can damage the kidneys, frequently leading to both acute and chronic kidney disease. Treatment becomes more difficult for such problems. Physicians may alter chemotherapy regimens and utilize kidney-protecting medications to lessen renal damage. New imaging techniques and biomarkers also aid in the early detection of renal issues. To effectively handle the mentioned situation, oncologists, nephrologists, and pharmacists must collaborate. However, additional study is still required to develop customized therapies, discover strategies to minimize kidney injury and produce new platinum medicines. Hereupon, the present review's authors are being sought to address the causes, prospective treatments, and management of nephrotoxicity caused by platinum-based chemotherapy.

Although significant progress in identifying molecular mediators of fibrosis is made, there is still controversy regarding the role and mechanism of autophagy in kidney fibrosis. Here, this study finds that autophagy related 5 (ATG5) is obviously increased in uric acid (UA), aristolochic acid (AA) and transforming growth factor-β1 (TGF-β1)-induced HK-2 cells, as well as in kidneys from patients with chronic kidney disease (CKD) and mice with hyperuricemic nephropathy (HN), aristolochic acid nephropathy (AAN) and unilateral renal ischemia-reperfusion injury (uIRI). Conditional deletion of ATG5 in HN, AAN and uIRI murine models significantly alleviated aberrant glycolysis, attenuated pathological lesions, and improved kidney function. Mechanistically, ATG5 mediates the binding between heat shock protein 90 (HSP90) and hypoxia-inducible factor 1alpha (HIF-1α), thereby enhancing the stability of HIF-1α and further promoting the overactivation of glycolysis. Subsequently, the aberrant glycolysis facilitated the occurrence of mitochondrial fission and inflammatory response, thus leading to kidney fibrosis. Taken together, the study provides solid evidence supporting that persistent activation of ATG5 in kidney tubules promotes kidney fibrosis. The profibrotic function of ATG5 is related to the regulation on HSP90-HIF-1α-mediated glycolysis, resulting in mitochondrial fission and renal inflammation. Thus, ATG5 may be a novel therapeutic target for kidney fibrosis.

Chronic kidney disease is defined by the presence of kidney damage or decreased kidney function for at least three months, irrespective of the cause. Hypertensive kidney disease is one of the long-term complications of poorly controlled hypertension. It is the second leading cause of developing chronic kidney disease, next to diabetic mellitus.

The literature was searched using an international electronic database (PubMed, Google Scholar, Hinari, and Open Google) to get significant studies on chronic kidney disease among hypertensive patients. This study is conducted to determine the pooled prevalence and associated factors of chronic kidney disease among hypertensive patients up to May 20, 2024. Heterogeneity between studies was checked using I2 test statistics, and small study effects were checked using graphical and Egger's statistical tests at a 5% significance level. Subgroup analysis and sensitivity analysis were checked. A random-effects model was used to guess the pooled effect size across studies.

In this meta-analysis, 16 studies in sub-Saharan Africa were included with a total of 6648 participants who fulfilled the inclusion criteria. The estimated prevalence of CKD among hypertension patients was found to be 29.01% (95% CI: 23.03-34.99, I2 = 97.10%) in sub-Saharan Africa. Age greater than 60 years old (OR = 2.36; 95% CI: 1.02-3.71, I2 = 99.11%), uncontrolled blood pressure (OR = 6.57; 95% CI: 2.44-10.71, I2 = 97.38%), hypertensive patients with diabetes comorbidity (OR = 3.27; 95% CI: 1.65-4.89, I2 = 95.79%), Bing overweight (OR = 2.75; 95% CI: 1.04-4.46, I2 = 98.22%), and proteinuria (OR = 4.64, 95% CI: 4.09-5.18, I2 = 0.00%).

Hypertension is one of the major causes of chronic kidney disease. Most patients living with hypertension develop CKD over time in sub-Saharan Africa. The highest prevalence of CKD among hypertension was observed in West Africa and Middle Africa.

Oxidative stress is a well-known underlying mechanism for several diseases in response to environmental pollution. Although there is a lack of evidence on the relationship between air pollution and an established risk factor for urogenital dysfunction. The aim of this study was to investigate the mechanism of particulate matter (PM) on urogenital function and evaluate the potential efficacy of chlorogenic acid (CGA) in preventing urogenital damage in rats. Forty Wistar rats were divided into five groups (n = 8): control, particulate matter exposure (animals were exposed to fine dust in an inhalation chamber for 4 weeks, 3 days a week, for 3 h, PM10 concentration adjusted to 500-2000 µg/m3), and particulate matter plus 3 concentrations of chlorogenic acid (100, 200, and 400 mg/kg, gavage, 4 weeks, 3 days a week). At the end of the study, kidney biomarkers, oxidative stress markers, antioxidant enzymes, the oxidation resistance 1 (OXR1) and its downstream gene expression, sperm count, gonadotropin hormones, and the structure of the kidney, epididymis, and seminal vesicle were evaluated in response to PM exposure and CGA treatment in all groups. The data obtained from the current study showed that PM exposure led to kidney dysfunction and inhibition of oligospermia through oxidative stress, as evidenced by an increase in MDA and a decrease in TAC, SOD, CAT, and GSH concentration levels in blood samples. These results were consistent with the down-regulation of OXR1, Nrf2, and P21 gene expression. In contrast, CGA improved urogenital biomarkers and histopathology structures of the kidney, epididymis, and seminal vesicle by enhancing antioxidant defense system enzymes and modulating the OXR1 signaling pathway. Our findings suggest that environmental air pollution contributes to kidney dysfunction and urogenital damage. Modulation of oxidative stress through the OXR1, P21, and Nrf2 signaling pathways may be the underlying mechanism. Furthermore, chlorogenic acid supplementation could be recommended as a new protective or treatment strategy to safeguard urogenital function against exposure to particulate matter.

Chronic kidney disease or chronic renal failure is a progressive condition defined as abnormalities of kidney structure or function, present for longer than 3 months. It is estimated to affect more than 10% of the general population worldwide. Management of CKD represents an especially large burden for the health systems of low- and middle-income countries, and it has been recognized as a leading public health problem. Previous research articles reported an age-adjusted prevalence of 7.6% for Romania, but the hospital costs generated by CKD are unknown. The present research article aimed to measure the hospital costs and one-year national healthcare budget impact of CKD, excepting the chronic care costs of RRTs.

In this retrospective study we reviewed the electronic health records of 4 University, 3 County and 5 City hospitals from 1st of January 2019 to 31st of December 2019 in order to calculate costs related to hospitalization due to chronic kidney disease. Inclusion criteria were defined as: CKD-related diagnostic codes or dialysis-related procedures in medical cases (without surgical interventions). KDIGO severity grades 1-5 were considered, including dialysis costs. The costs generated by the chronic care of RRTs were not considered here. Hospitalization cost calculation was based on hospital controlling methodology including direct, indirect and overhead costs. For the national-level burden study, we analyzed the health claim records of all public and private hospitals for 2019.

In 2019 a total number of 229 276 cases reported chronic kidney disease in Romania. The average hospital costs per patient episode was €917.1, with significantly higher costs in cases with complications or higher severity grades. The total hospitalization cost-related budget impact in 2019 was €210 million.

The high hospitalization costs of CKD (representing 2.6% of the NHIH budget, not considering the funds for sick leave) cause major impact on the national health payer`s budget. Preventive strategies, early diagnosis and management as well as health education measures could act as means of mitigation. Our results should warn the public health policy decision makers about the importance of this disease.

Chronic kidney disease (CKD), hypertension, and diabetes are associated with dementia, and insulin resistance promotes vascular dysfunction resulting in dementia. However, the study of insulin use in preventing dementia in CKD patients with diabetes and hypertension is limited. We aim to assess the effects of insulin use on the incidence of dementia in patients with CKD with hypertension and diabetes.

A retrospective cohort study using the nationwide database from Taiwan's National Health Insurance Research Database. We selected 11,758 CKD patients with diabetes and hypertension in 2006, including 5,864 insulin users and 5,894 non-insulin users. Moreover, their medication possession ratios (MPR) were calculated.

We used the competing risk model to estimate the hazard ratio (HR) for the incidence of dementia for insulin use in the target population.

In a follow-up period of 11 years, 1285 events of dementia were recorded, and the multivariate-adjusted HR for dementia by insulin usage (yes vs. no) and insulin usage per MPR is 0.652 (95% confidence interval [CI]: 0.552 to 0.771) and 0.995 (95% CI: 0.993 to 0.998) respectively. Such a significant negative association was consistent in almost all subgroups. Moreover, a dose-dependent effect of insulin was noted, where patients with higher insulin MPRs were less likely to have dementia.

The CKD patients with hypertension and diabetes who received insulin therapy had a 35% decreased risk of dementia.

Inadequate self-management has a significant impact on the mortality and morbidity of patients undergoing hemodialysis. The capacity for self-management is contingent on demographic, clinical, psychosocial, and cognitive factors. In particular, the role of family support and quality social interactions in this process is significant. The Individual and Family Self-Management Theory (IFSMT) emphasizes the integration of self-management into the lifestyles of the individual and family. Therefore, this study aimed to investigate the factors that affect self-management in patients undergoing hemodialysis based on IFSMT. Data were collected from three tertiary-level hospitals in Korea from May to October 2021. A total of 140 patients with chronic kidney disease undergoing hemodialysis completed a structured self-report questionnaire comprising questions on general characteristics, complexity of disease management, accessibility to healthcare services, health literacy, family functioning, self-efficacy, self-regulation, social support, and self-management behaviors. Data were analyzed by descriptive statistics, independent t-test, one-way ANOVA with Scheffé test as post-hoc analysis, Pearson's correlation analysis, and hierarchical multiple regression analysis. The study found that self-management in patients undergoing hemodialysis was influenced by "health literacy" contextual factor and "self-efficacy," "self-regulation," and "social support" process factors, based on the IFSMT framework. These factors accounted for 45.0% of the variance in self-management. These findings highlight the importance of the IFSMT in predicting self-management behavior in patients undergoing hemodialysis. It is essential to develop a comprehensive intervention that incorporates these contextual and process factors within the family setting, and future research should evaluate its effectiveness.

Previous studies have established a correlation between the microbiome-derived metabolite trimethylamine N-oxide (TMAO) and decreased renal function, but with great heterogeneity. Moreover, population-based evidence remains scarce, particularly in Chinese populations. We designed a meta-analysis and a population-based cross-sectional study in China to examine the associations between TMAO and chronic kidney disease (CKD). In meta-analysis, among 2125 pooled subjects with 1240 controls and 885 CKD patients, a significant association was observed between TMAO and CKD, with a standardized mean difference of - 0.93 (95% confidence interval: - 1.11, - 0.75). Meta-regression analysis identified gender, age, and body mass index (BMI) as significant heterogeneity factors. In our population-based study of 5584 subjects with an estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 from Sijing community, 100 developed CKD in 2 years. We matched 195 controls by age and gender from the 5484 non-CKD subjects. Male subjects and alcohol consumers exhibited a lower risk of CKD with adjusted odds ratio (OR) of 0.471 (P < 0.05) and 0.320 (P < 0.05), respectively. When comparing subjects in the lowest tertile of TMAO, adjusted OR reached to 1.243 (P > 0.05) for those in the middle and 2.123 (P < 0.05) in the highest tertile (P for trend < 0.05). TMAO demonstrated a moderate capacity to distinguish CKD from non-CKD subjects (AUC = 0.614, P < 0.01). Our findings indicate TMAO is significantly associated with the risk of CKD, and suggest age, gender, and BMI may confound the relationship between TMAO and CKD. KEY POINTS: • Subjects with elevated TMAO levels have an increased risk of CKD. • TMAO demonstrates a moderate capacity to distinguish CKD from non-CKD cases. • Age, gender and BMI may confound the relationship between TMAO and CKD.

The aim of this study was to identify the clinical factors associated with serum trough concentrations of vancomycin crystalline degradation product (CDP-1) and to determine the impact of CDP-1 on chemiluminescence microparticle immunoassay (CMIA) results among patients with chronic kidney disease (CKD).

In this retrospective observational study, patients with CKD who were receiving vancomycin intravenously were included if steady-state serum trough levels of vancomycin were available. Patients were allocated to three groups on the basis of their estimated creatinine clearance (eCrCl) on the day of trough level monitoring: G1 (60 < eCrCl ≤ 90 mL/min), G2 (30 < eCrCl ≤ 60 mL/min), and G3 (eCrCl ≤ 30 mL/min). CDP-1 serum concentrations were determined via ultra-high performance liquid chromatography‒tandem mass spectrometry (UPLC‒MS/MS). Vancomycin serum concentrations measured via CMIA were compared with those measured via UPLC‒MS/MS. Multiple linear regression analyses were performed to identify factors associated with the CDP-1 concentration and the ratio of vancomycin concentration determined via CMIA to vancomycin concentration via UPLC‒MS/MS (VCMIA/VUPLC-MS/MS).

Among the 167 patients included, 49 (29.34%), 69 (41.32%), and 49 (29.34%) were allocated to G1, G2, and G3, respectively. There were significant differences in the CDP-1 trough concentrations and VCMIA/VUPLC-MS/MS ratios between the three groups. In the multivariate analysis, eCrCl levels (P < 0.001), the time interval from the initial dose to the trough level (P < 0.001), and vancomycin dose (P < 0.001) were associated with CDP-1 trough concentrations. The CDP-1 trough concentration was positively associated with the VCMIA/VUPLC-MS/MS ratio (P = 0.002).

Delayed timing of trough level sampling could contribute to increased CDP-1 levels and the overestimation of vancomycin levels, especially in patients with severe deterioration in renal function. It may be necessary to increase the frequency of TDM and select quantitative methods to measure vancomycin serum levels without interfering with CDP-1.

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.

Extrahepatic manifestations of chronic hepatitis B virus (HBV) infection include development of kidney disease (KD). While anti-HBV treatment reduces the risk of liver-related events, the impact of HBV treatment on KD remains unclear. Using a large US-based electronic medical record (EMR) database, we examined whether patients with HBV are at higher risk of developing KD, whether the development of KD is associated with HBV-related liver disease, and whether anti-HBV treatment mitigates these risks.

Data were queried from the IQVIA Ambulatory EMR database from 2006 to 2020. Propensity score matching was performed to better ensure balance across analyses. A Cox proportional hazards model was used to estimate hazard ratios (HRs) with 95% CIs for onset of KD between groups.

Among patients with and without HBV (n = 11,772 each), those with HBV were more than twice as likely to develop KD vs. matched controls without HBV infection (HR, 2.18 [95% CI, 1.90-2.50]; p < 0.001); most events occurred after age 55 years. Patients with HBV and concomitant hypertension, diabetes, or obesity had a greater likelihood for development of KD by age 75 years (19% with HBV vs. 6% without HBV); the cumulative probability of developing KD among patients with HBV along with concomitant comorbidities surpassed the additive risk of developing KD among those who had the comorbidities without HBV or only had HBV. Among patients with HBV, advanced liver disease was not significantly associated with KD. Patients treated with antivirals had a lower risk for KD compared with untreated HBV patients (HR, 0.61 [95% CI, 0.42-0.87]; p < 0.01).

HBV infection contributes to the development of KD, and anti-HBV treatment can lower KD risk. As such, clinicians should consider screening patients for HBV infection or initiating treatment early, particularly in patients with risk factors for KD.

Enarodustat is a hypoxia-inducible factor-prolyl hydroxylase inhibitor. We evaluated the pharmacokinetics, pharmacodynamics, and safety profile of domestic enarodustat (SAL-0951) and analyzed the influence of ethnic factors.

In this phase I study, healthy Chinese participants received single and multiple oral doses (1, 5, and 15 mg) of SAL-0951 while in a fasted state. We monitored the pharmacokinetics, pharmacodynamics, and safety characteristics and analyzed the impact of ethnicity on pharmacokinetic characteristics.

In total, 33 healthy Chinese participants were enrolled; the mean age was 31.2 ± a standard deviation of 5.5 years. After single doses of 1, 5, and 15 mg were administered under fasted conditions, SAL-0951 was rapidly absorbed. Mean maximum plasma concentration and area under the plasma concentration-time curve from time 0 to the last quantifiable concentration increased dose proportionately from 0.14 to 2.54 μg/mL and from 0.63 to 9.50 h × μg/mL, respectively. The elimination half-life was 6.13, 6.32, and 6.74 h, respectively, in these three groups, and the mean value of apparent clearance ranged from 1.64 to 1.89 L/h. SAL-0951 was excreted mostly as the parent compound. It reached a stable concentration after 5 days of multiple-dose administration. We observed no drug accumulation or time-dependent pharmacokinetic characteristics and no significant difference in pharmacokinetic characteristics between Chinese and Japanese participants.

SAL-0951 was safe and well tolerated in healthy Chinese participants and had a linear pharmacokinetic profile. We found no ethnic differences in the pharmacokinetic characteristics of the drug between Chinese and Japanese populations.

Registered at Chinadrugtrials.org.cn, registration number CTR2020245.

Chronic kidney disease (CKD) is a complex health condition characterized by the gradual loss of renal function, often leading to end-stage renal disease (ESRD). It results from a combination of medical, environmental, and genetic factors. Predicting the rate of renal function decline and effectively managing the progression to ESRD is challenging in clinical practice. CKD assessment involves various indicators, including estimated glomerular filtration rate (eGFR), albuminuria levels, serum creatinine, and others. This study aimed to explore the predictive potential of specific blood cell indexes in forecasting further renal function decline and the transition from CKD stage 3-4 to ESRD. We assessed the following blood cell indexes in 377 CKD stage 3-4 patients: absolute neutrophil count (ANC), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), derived NLR (dNLR), mean platelet volume (MPV), aggregate index of systemic inflammation (AISI), and systemic inflammation index (SII). ANC, MPV, NLR, PLR, dNLR, and SII were found to independently predict a rapid decline in eGFR. Notably, NLR and dNLR demonstrated the highest sensitivity and specificity with cut-off values of 3.36 and 2.45, respectively (NLR: 88.6 and 81.7%; dNLR: 85.2 and 75.8%). The corresponding area under the ROC curve values were 0.877 (95% CI 0.837-0.918, p < 0.001) for NLR and 0.849 (95% CI 0.805-0.892, p < 0.001) for dNLR. However, none of the blood cell indexes independently predicted the transition to ESRD. The NLR and the dNLR exhibited the highest predictive capacity towards a rapid decline in renal function in CKD. No blood cell index, however, independently predicted the transition into ERSD.

Early detection of chronic kidney disease (CKD) could slow its progression; however, most patients in earlier stages remain undiagnosed. Our study objective was to assess the cost-effectiveness of multinational CKD screening strategies from the payer perspective across general and higher-risk populations.

Using the published Inside CKD microsimulation, we projected virtual closed populations to assess CKD screening strategies in 31 countries or regions over a lifetime horizon. We considered people aged ≥ 65 or ≥ 45 years in the general population and in high-risk subgroups (type 2 diabetes [T2D], hypertension, or cardiovascular disease [CVD]). Simulated populations could receive 2 serum creatinine (SCr) tests assessing estimated glomerular filtration rate (eGFR), "2 eGFR only", or an additional urinary albumin-to-creatinine ratio test (UACR), "2 eGFR and 1 UACR", versus current practice. Eligible patients received renin-angiotensin system inhibitors (RASi).

Screening the general population aged ≥ 45 years for CKD was cost-effective versus current practice in all countries or regions using the "2 eGFR and 1 UACR" strategy, and cost-effective in all but 1 country using the 2 eGFR only strategy. The 2 eGFR and 1 UACR strategy showed consistently higher cost-effectiveness. Screening general populations aged ≥ 45 years increased projected CKD diagnosis rates per 100,000 persons eligible for screening from 459 by current practice to 7475 patients using 2 eGFR only, or 14,392 using 2 eGFR and 1 UACR. Similar trends in cost-effectiveness and diagnosis rates were observed in persons aged ≥ 65 years.

CKD screening may be cost-effective in general populations worldwide, including in populations aged ≥ 45 years. Our analysis corroborates global guideline recommendations for simultaneous eGFR and UACR testing if considered in the context of local factors.

The global prevalence of end-stage kidney disease (ESKD) is increasing despite optimal management of traditional risk factors such as hyperglycaemia, hypertension, and dyslipidaemia. This study examines the influence of cardiorenal risk factors, socioeconomic status, and ethnic and cardiovascular comorbidities on ESKD outcomes in the general population.

This cross-sectional study analysed data from 502,408 UK Biobank study participants recruited between 2006 and 2010. Multivariable logistic regression models were fitted to assess risk factors for ESKD, with results presented as adjusted odds ratio (aOR) and 95% confidence intervals (95% CI).

A total of 1191 (0.2%) of the study participants reported ESKD. Diabetes increased ESKD risk by 62% [1.62 (1.36-1.93)], with early-onset diabetes (before age 40) conferring higher odds compared to later-onset (after age 40) [2.26 (1.57-3.24)]. Similarly, early-onset hypertension (before age 40), compared to later onset (after age 40), increased ESKD odds by 73% [1.73 (1.21-2.44)]. Cardiovascular comorbidities, including stroke, hypertension, myocardial infarction and angina, were strongly associated with ESKD [5.97 (3.99-8.72), 5.35 (4.38-6.56), 4.94 (3.56-6.78), and 4.89 (3.47-6.81)], respectively. Males were at 22% higher risk of ESKD than females [1.22 (1.04-1.43)]. Each additional year of diabetes duration increased ESKD odds by 2% [1.02 (1.01-1.03)]. Non-white ethnicity, compared to white and socioeconomically most deprived, compared to the least deprived quintiles, were at 70% and 83% higher odds of ESKD. Each unit of HbA1c rise increased the odds of ESKD by 2%. Compared to microalbuminuria, macroalbuminuria increased the odds of ESKD by almost 10-fold [9.47 (7.95-11.27)] while normoalbuminuria reduced the odds by 73% [0.27 (0.22-0.32)].

Early onset of diabetes and hypertension, male sex, non-white ethnicity, deprivation, poor glycaemic control, and prolonged hyperglycaemia are significant risk factors for ESKD. These findings highlight the complexity of ESKD and the need for multifactorial targeted interventions in high-risk populations.

Not applicable.

Chronic kidney disease (CKD) affects 10% of the world's population (namely, 800 million of people) and an increase in CKD prevalence has been observed over the years. This phenomenon in developed countries is related to the spread of chronic degenerative non-communicable diseases (CDNCDs), such as diabetes mellitus, arterial hypertension, obesity, etc., while in low-income to middle-income countries, the CKD prevalence is attributable not only to CDNCDs, but also to infection conditions (like HIV, hepatitis, etc.). Another important difference lies in the age of onset of CKD, which is about 20 years lower in developing countries compared to developed ones. Therefore, CKD is becoming a public health problem, requiring preventive and treatment strategies to counteract its spread and to slow its progression. Moreover, the healthcare costs for the CKD management increase as the disease progresses. In this regard, the approach to prevent and reduce the CKD progression involves pharmacological and nutritional treatments (like Mediterranean Diet, MedRen diet, Flexitarian Diet, Vegetarian Diet and Plant-dominant Low Protein Diet) in order to improve the patients' quality of life and, at the same time, promote the environmental sustainability. Recent studies have highlighted the benefits of these diets not only for individuals, but also for environment. In particular, plant-based diets have increasingly gained an important role in the prevention and management of chronic diseases, including CKD. In fact, recent scientific studies have highlighted how a greater adherence to predominantly plant-based diets, is associated with a lower risk in developing CKD and also in slowing its progression. With regard to environmental sustainability, it is known how our food choices influence the climate crisis, since the food sector contributes for the 25% to the greenhouse gas emissions. Therefore, to reduce the consumption of animal proteins and to replace them with plant-based proteins are key strategies for sustainability and health, also supported by the European policies. In this context, food industries are starting to increase the offer of plant-based products that have similar characteristics, both sensorial and nutritional, to those of animal origin. This innovation, in fact, presents difficulties due to the perception of taste and the organoleptic appearance of these products. An additional challenge concerns the resistance of the traditional food industry and the lack of awareness of the consumer. The paradigm shift is dictated by the obtained benefits for health and for environment. Life cycle assessment studies have compared the land footprint, carbon footprint and blue water footprint of plant-based products with those of animal origin and pointed out the lower environmental impact of the former. In conclusion, the adoption of sustainable food models will slow down the spread of CDNCDs, such as CKD, positively impacting both on human health and on planet, significantly reducing the costs and resources of the National Health Systems, since they absorb up to 70%-80% of the healthcare costs.

Retrospective cross-sectional study aimed to investigate the postoperative outcomes following anterior cervical discectomy and fusion (ACDF) surgery in patients with end-stage renal disease (ESRD) and renal transplant recipients, using data from a large national database. Three patient groups were analyzed: control group, ESRD group, and renal transplant group.

To investigate the postoperative outcomes following ACDF surgery in patients with ESRD and renal transplant recipients, utilizing data from a large national database.

Patients with ESRD and renal transplant recipients face unique health challenges, and there is a paucity of comprehensive research examining their postoperative surgical experiences, especially in the context of spine surgery.

Data from 158,101 ACDF procedures performed between 2016 and 2019 were analyzed. Patients were stratified into 3 groups: control, end-stage renal failure, and renal transplant. The primary outcomes included 30-day medical complications, 30-day intensive care unit admissions, 90-day readmissions, and 1-year revision surgery. Multivariable logistic regression was employed for analysis.

Patients with ESRD had significantly higher rates of 30-day medical complications (56%) and 90-day readmissions (38%) compared with the control patients (3% and 3%, respectively). Renal transplant patients also showed elevated rates of medical complications and readmissions, 12% and 10%, respectively, but lower than patients with ESRD. Patients with ESRD had significantly higher odds of intensive care unit admission. There were no significant differences in revision rates among the groups.

Patients with ESRD and renal transplant recipients undergoing ACDF surgery face increased risks of medical complications and readmissions, with patients with ESRD showing surprisingly high rates. Tailored care strategies and close monitoring are crucial for these patient cohorts, emphasizing the need for specialized postoperative care. The study's findings highlight the multifaceted nature of surgical outcomes in medically complex populations and the importance of holistic assessment.

Kidney diseases complicate treatment prediction and progression. This study introduces a Metaheuristic Red Fox-Optimized Agile Support Vector Machine (MRFO-ASVM) for early detection and prognosis of kidney diseases. Nurses' involvement in data collection and analysis enhances model effectiveness. Pre-processing with Min-Max normalization and feature extraction using Principal Component Analysis (PCA) improves data quality. The MRFO-ASVM obtained enhanced parameter performance of the model including high accuracy (0.92), F1-score (0.67), sensitivity (0.89), precision (0.63), and ROC-AUC (0.99). Integrating this technology into nursing practice enhances early detection and personalized care, advancing patient-centred healthcare solutions.

There is a growing body of clinical research on the utility of synthetic data derivatives, an emerging research tool in medicine. In nephrology, clinicians can use machine learning and artificial intelligence as powerful aids in their clinical decision-making while also preserving patient privacy. This is especially important given the epidemiology of chronic kidney disease, renal oncology, and hypertension worldwide. However, there remains a need to create a framework for guidance regarding how to better utilize synthetic data as a practical application in this research.

To evaluate the diagnostic value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SIRI) in peritoneal dialysis-associated peritonitis (PDAP).

In this retrospective study, the clinical data from 130 patients who underwent peritoneal dialysis (PD) for the first time at the Cangzhou Central Hospital from January 2019 to January 2022 were rigorously reviewed and analyzed. Based on the occurrence of PDAP during treatment, patients were classified into the peritonitis group (n=31) and the non-peritonitis group (n=99). The expression levels and diagnostic value of NLR, PLR, and SIRI were analyzed in the contest of PDAP. Pearson correlation analysis was performed to examine the correlations between NLR, PLR and SIRI in PDAP patients, and the joint diagnostic value of NLR, PLR, and SIRI was evaluated. Additionally, risk factors associated with PDAP were identified.

Patients in the peritonitis group were older than those in the non-peritonitis group, and experienced longer duration of dialysis (P<0.05). The peritonitis group exhibited significantly higher NLR, PLR and SIRI levels than the non-peritonitis group (P<0.001). Pearson correlation analysis revealed significant positive corrections between NLR, PLR and SIRI in PDAP patients. Logistic regression analysis identified NLR, PLR, and SIRI as independent influencing factors for the occurrence of PDAP. ROC curve analysis revealed that the combined use of NLR, PLR, and SIRI for diagnosing PDAP yielded an AUC of 0.935, significantly higher than their individual predictions, along with superior diagnostic accuracy.

NLR, PLR, and SIRI are independent risk factors for the occurrence of PDA. These indices hold significant diagnostic value for PDAP, and their combined utilization can enhance diagnostic accuracy.

Chronic kidney disease (CKD) is a major global public health problem with increasing prevalence and a huge health and economic burden. Diabetes mellitus and hypertension are major risk factors for CKD, and CKD is associated with cardiovascular disease and end-stage renal disease. Understanding the prevalence and burden of CKD is essential for the development of prevention and control strategies.

Using data from the Global Burden of Disease Study (GBD) 2021 study, this study analyzed the incidence, prevalence, and disability-adjusted life years (DALYs) of CKD at global, regional, and national levels between 1990 and 2021. Decomposition analysis, health inequalities and frontier analysis were used to analyse the changes.

This study analyzed the global regional and national burden, trends, and disparities of CKD from 1990 to 2021 and found that the global burden of CKD had increased significantly, in line with trends in population ageing and population growth, and with significant variations between regions. There were 673.7 million people with CKD worldwide in 2021, accounting for 8.54% of the global population, a 92.0% increase from 1990. Despite a slight decline in age-standardized prevalence rate (ASPR), the absolute number of CKD cases increased. Central Asia had the highest prevalence of CKD, while Central Latin America had the highest rate of DALYs and incidence for CKD. In 2021, At the national level, China had the highest number of new CKD cases. The country with the highest ASPR and age-standardized DALYs rate (ASDR) of CKD was Mauritius. Globally, age-standardized incidence rate (ASIR) and ASDR were on the rise in almost all countries/regions, suggesting that the impact of CKD on global health is increasing. Population growth and ageing were major factors contributing to the increasing burden of CKD, especially in China and low Socio-demographic Index (SDI) regions. In addition, the cross-national study of health inequalities in CKD showed that, although there have been improvements in global health over time, health inequalities continue to exist. The frontier analysis revealed a considerable degree of heterogeneity in the effective differences across the spectrum of socio-demographic indices.

CKD is a global health problem, the burden of which varies between regions and countries. A multifaceted approach is necessary to prevent and control CKD, including population-level interventions targeting risk factors, improvements in the accessibility and quality of health care, and measures to address health inequalities.

Raising awareness of chronic kidney disease (CKD) is essential for early detection and prevention, since the condition remains largely underdiagnosed, particularly in primary care settings. The present study aimed to evaluate awareness levels regarding the causes and symptoms of CKD among individuals receiving primary care.

This cross-sectional study included 457 participants recruited from two primary care centers in Türkiye using systematic random sampling. The data were collected via face-to-face interviews using a pre-tested questionnaire between April and June 2023. Awareness levels were classified using Bloom's cutoff points-high awareness (≥ 80%), moderate awareness (60-79%), and low awareness (< 60%).

The mean age of the participants was 42.3 ± 14.9 years. The study population consisted of 55.4% women, 51.2% of the participants were aged 18-39, 74.6% were married, and 53.4% held at least a university bachelor's degree. As for CKD awareness, 64.1% were aware that CKD can be caused by pain medication, 56% that it can be caused by hypertension, and 48.8% that it can result from diabetes. Additionally, 58.6% were aware that swelling of the feet and ankles can represent a symptom of CKD. Awareness of the causes and symptoms of CKD was low in 78.6% of our participants (n = 359), moderate in 17.5% (n = 80) and high in 3.9% (n = 18). Individuals who recalled having been informed about these causes and symptoms by their primary care physicians exhibited higher awareness. No significant differences in awareness were observed across different sociodemographic groups. A positive correlation was observed between awareness of the causes of CKD and awareness of its symptoms.

Awareness of CKD causes and symptoms among the participants was limited, nearly half being unaware of key risk factors such as painkiller use, obesity, hypertension, smoking, diabetes, and herbal product use. Increased education, particularly by primary care physicians, may improve awareness and early detection rates.

Kidney transplantation was an effective method for treating chronic kidney failure via transplanting a healthy kidney from a donor to a patient with the loss of kidney function. However, clinical studies revealed that the posttransplantation status of patients was associated with a substantial aggregation of risk factors contributing to metabolic syndrome.

This article provided a comprehensive review of the current researches on metabolic syndrome after kidney transplantation, and the latest advances in the interaction between metabolism and immune cells were also covered.

Our aim was to identify and intervene high-risk recipients in time and thus improving the prognosis of recipients.

Hemodialysis patients, particularly the elderly, present challenges for vascular access (VA) creation due to age-related vascular changes and comorbidities. This study aimed to characterize outcomes related to VA in elderly patients (≥75 years) and compare them with younger patients, focusing on primary failure, maturation failure, and patency rates.

This retrospective study included patients evaluated in VA consultations between January 2019 and December 2021; patients were evaluated through physical examination and Color Doppler Ultrasound to determine the suitability of vessels for VA construction. Demographic data, proposed and created VA types were assessed. The primary outcomes were the evaluation and comparison of primary failure and maturation failure of VA in the elderly (O) and younger (Y) groups. Secondary outcomes included the assessment of primary patency and primary assisted patency at 6, 12, and 24 months in both groups.

Among 167 patients, 36 were elderly. There were no significant differences in proposed and created VA types between the Y and O groups and radial-cephalic AVFs were the most commonly constructed VA in both groups. Primary and maturation failure rates were similar (Y group: 17.3% and 5.6%; O group: 9.7% and 10.7%, respectively). Primary patency and primary assisted patency rates did not significantly differ between groups at 6, 12, and 24 months.

The impact of age on the feasibility of VA should not be exaggerated. Preoperative assessment and a tailored approach enable successful autologous access creation in elderly patients, resulting in outcomes comparable to those of younger patients.