Ongoing changes in healthcare are expected to significantly reshape the hospital landscape in the coming years. Within this context and in order to respond appropriately, an up-to-date assessment of the structural and process quality of dialysis access care is essential. Between April and July 2024, 160 German inpatient nephrology departments were invited to participate in an anonymous online survey. Data were analysed descriptively. A total of 64 hospitals responded (response rate: 40%). Of these, 23% (n = 15) were university hospitals, 45% (n = 29) were tertiary care providers, and 32% (n = 20) were primary (n = 1) or secondary care hospitals (n = 19). 19% (n = 12) were certified as a dialysis access centre. Availability of dialysis access surgery like arteriovenous fistulas (AVF), tunnelled-haemodialysis catheters (tHDC), and peritoneal dialysis (PD) catheters procedures was generally rated as good, with 80% performed in an inpatient setting. Satisfaction with access to AVF interventions trends to decrease with increasing hospital size. Overall, 58% of respondents favoured greater nephrology involvement, particularly in tHDC placement (92%), PD catheter placement (36%), and AVF procedures (44%). Nevertheless, only 25% reported planning to expand nephrological interventions. Key barriers included limited hands-on experience, lack of structured training curricula, inadequate infrastructure, and interdepartmental competition. Economic pressure and the shift toward outpatient care were cited as additional challenges. Most hospital nephrologists are satisfied with the service and timely availability of dialysis access surgery or interventions. While there is a strong desire to increase nephrological involvement, only a few hospitals plan to expand these services. Standardized training programs are needed to strengthen the field of interventional nephrology. The online version contains supplementary material available at 10.1186/s12882-026-04988-w.
Oxidized albumin has emerged as a promising biomarker in blood for assessing oxidative stress and multiple organ dysfunction. Recent advances suggest its potential detectability in urine, offering a noninvasive avenue for early diagnosis and monitoring of kidney disease. This review synthesizes current knowledge on oxidized albumin, its pathophysiological relevance, and the evolving methodologies for its detection, highlighting its translational potential in clinical nephrology.
Body composition parameters (such as BMI and waist-to-hip ratio) have a certain predictive value for blood pressure. In patients undergoing maintenance hemodialysis (MHD), BMI can affect dialysis adequacy and blood pressure control levels, and there are differences in body composition at different BMI levels. The aim of this study was to investigate the association between hypertension during dialysis and body composition in non-overweight/overweight obese patients. A total of 248 patients undergoing maintenance hemodialysis (MHD) at this center were enrolled. Body composition was measured using an InBody bioelectrical impedance analyzer prior to dialysis. Intra-dialysis blood pressure data from the preceding three months were collected via the hemodialysis system. Patients were categorized based on their dry weight at enrollment: those with BMI < 23 kg/m² were classified as the non-overweight group, and those with BMI ≥ 23 kg/m² as the overweight/obese group. LASSO regression was employed to identify body composition variables associated with hypertension during hemodialysis. Based on LASSO regression results, multivariate linear regression and logistic regression analyses were conducted to evaluate the impact of pre-dialysis body composition on blood pressure (BP) in non-overweight and overweight/obese hemodialysis patients. The overall prevalence of hypertension was 86% (214/248), and the proportion of overweight/obese patients was 41.0% (102/248). TBW and Protein were positively correlated with hypertension in non-overweight male patients (OR (95% CI): 1.28 (0.34-1.98); OR (95% CI): 1.97 (1.51-3.33)), and BMC was negatively associated with hypertension in non-overweight male patients (OR (95% CI): 0.10 (0.01-0.70)). In overweight obese female patients, Fat was positively associated with hypertension (OR (95% CI): 1.12 (1.01-2.26)). This study identified risk factors for elevated blood pressure associated with gender and BMI in a subset of the MHD Asian population. The study also provided evidence that different body composition factors (such as total body water, protein, bone mineral content, and fat) drive hypertension risk in different MHD subgroups, rather than being determined solely by BMI.
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Obinutuzumab is a novel glycoengineered type II anti-CD20 monoclonal antibody with more potent and sustained B-cell depletion than rituximab. This study aimed to evaluate the efficacy and safety of obinutuzumab monotherapy in adult patients with minimal change disease (MCD). We conducted a retrospective study including adult MCD patients treated with obinutuzumab or glucocorticoids (GC) between January 1, 2020 and June 30, 2025. The primary outcome was complete remission (CR) of nephrotic syndrome. Secondary outcomes included relapse and adverse events. 38 patients were enrolled (16 in the obinutuzumab group, 22 in the GC group). 9 patients in the obinutuzumab group had steroid-dependent or steroid-resistant MCD, and 7 were new-onset MCD treated with obinutuzumab due to GC intolerance, contraindications, or comorbidities. In new-onset MCD, patients receiving obinutuzumab were older with higher prevalence of hypertension, BMI, and HbA1c. The CR rate was 68.8% (11/16) in the obinutuzumab group, with no significant differences in CR rate or time to remission compared with GC. Multivariate Cox regression showed that obinutuzumab treatment was not independently associated with CR. No relapses were observed in the obinutuzumab group during follow-up, whereas 27.3% of GC-treated patients relapsed. This single-center retrospective study provides preliminary evidence that obinutuzumab monotherapy may induce and maintain remission in selected adult MCD patients (e.g., those with GC contraindications or intolerance). While its remission rate is comparable to conventional GC therapy in our cohort, further prospective validation is required before it can be recommended as a routine alternative to GC.
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Chronic kidney disease-mineral bone disorder (CKD-MBD), a common complication of chronic kidney disease (CKD), leads to vascular calcification, osteoporosis, and electrolyte disturbances, impacting patient survival and quality of life. Conventional dialysis poorly removes protein-bound uremic toxins like p-cresyl sulfate (PCS), which are linked to CKD-MBD. This study combined metabolomics and transcriptomics to explore PCS's cytotoxic mechanisms in CKD-MBD for better clinical management. Using MC3T3-E1 osteoblasts treated with or without PCS, metabolic changes were analyzed via ultra-high performance liquid chromatography and quadrupole time-of-flight mass spectrometry (UHPLC-QTOF/MS), and transcriptomic changes through RNA sequencing (RNA-seq). UHPLC-QTOF/MS identified 74 significantly altered metabolites and 15 disrupted metabolic pathways in PCS-treated osteoblasts. RNA-seq revealed 3,679 differentially expressed genes, with pathway analysis indicating significant disruptions in glutathione and glycerophospholipid metabolism, and alterations in cell apoptosis, cell cycle, and DNA repair processes. Parallel metabolomics and transcriptomics profiling showed PCS-induced disruptions in glutathione and glycerophospholipid pathways are central to cellular metabolic dysfunction in CKD-MBD. These insights highlight the potential of multi-omics to elucidate uremic toxin pathophysiology, providing a foundation for improved CKD-MBD management.
Metabolic disorders are highly prevalent in patients with native and transplanted chronic kidney disease (CKD). However, little is known about the metabolic similarities and differences associated with declining kidney function between non-transplant patients and kidney transplant recipients (KTRs). This cross-sectional study employed gas chromatography-mass spectrometry to compare serum metabolomic profiles among native CKD subgroups and KTR subgroups, aiming to identify differential metabolites associated with kidney dysfunction in both clinical settings. 11 and 13 metabolites were associated with kidney dysfunction in native CKD patients and KTRs, respectively. Among these, L-tryptophan, D-lyxose, xylitol, erythritol, 3,4-dihydroxybutanoic acid and 2,4-dihydroxybutanoic acid were selected as common differential metabolites in both cohorts. Pathway analysis revealed that the pentose and glucuronate interconversions pathway was significantly affected in native CKD patients, whereas phenylalanine, tyrosine, and tryptophan biosynthesis pathway and tyrosine metabolism pathway were the most affected pathways in KTRs. Further comparisons between native CKD and KTRs who were at the same kidney dysfunction stages demonstrated that KTRs showed significantly higher levels of malic acid, but lower levels of D-allose compared to native CKD patients. Our study not only identified the 6 metabolites associated with kidney function in both non-transplant patients and KTRs, but also determined 5 and 7 metabolites that were specifically associated with kidney dysfunction in native CKD patients and KTRs, respectively. These data suggest that the metabolic process may be influenced by the unique characteristics of kidney transplantation, such as allogeneic immunity and immunosuppressive drugs, in KTRs.
To investigate the association between early statin use and acute kidney injury (AKI) risk in septic patients admitted to the intensive care unit (ICU). This study analyzed septic patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were divided into AKI and non-AKI groups based on whether they developed AKI during ICU stay. AKI was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The primary exposure variable was early statin use, defined as administration within the first 24 h of ICU admission. Multivariable logistic regression models were constructed to assess the association between early statin use and AKI risk, adjusting for demographic characteristics, clinical parameters, laboratory values, disease severity scores, and treatment-related factors. Subgroup analyses were performed across clinically relevant patient characteristics. Sensitivity analyses were conducted to assess the robustness of the primary findings. A total of 5102 septic patients were analyzed, with 2424 (47.51%) developing AKI during their ICU stay. Early statin therapy was administered to 1934 (37.91%) patients. The crude AKI incidence was 49.7% in the statin group and 46.1% in the non-statin group. After full adjustment for covariates, early statin use was associated with significantly lower odds of AKI (OR = 0.87, 95% CI: 0.76-0.99, P = 0.045). Among individual statins, simvastatin demonstrated the most consistent association (OR = 0.77, 95% CI: 0.62-0.95, P = 0.014). Subgroup analyses revealed that the association was observed in patients aged ≥ 60 years (OR = 0.85, 95% CI: 0.72-0.99, P = 0.042) and male patients (OR = 0.81, 95% CI: 0.68-0.96, P = 0.016), although no formal interaction tests reached statistical significance. Early statin use within 24 h of ICU admission may be associated with modestly lower odds of AKI in septic patients, with simvastatin showing the most consistent association across subgroups. Given the modest effect size, borderline statistical significance, and observational study design, these findings should be considered hypothesis-generating and require confirmation in prospective studies.
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Acute coronary syndrome (ACS) is a critical cardiovascular emergency frequently treated with percutaneous coronary intervention (PCI). Despite its benefits, PCI is associated with a substantial risk of periprocedural myocardial infarction (PMI), particularly among patients receiving multiple stents. This study aims to explore the incidence and determinants of PMI in ACS patients undergoing planned PCI in a clinically stable setting. This retrospective single-center study enrolled ACS patients undergoing planned PCI in a clinically stable setting between June 2018 and August 2022. Patients were classified into single-stent (SSG) and multi-stent (MSG) groups. PMI was defined by Academic Research Consortium-2 criteria, and multivariable logistic regression was used to identify factors associated with PMI. A total of 330 patients with ACS were initially screened, and 222 were ultimately included, comprising 126 in the single-stent group (SSG) and 96 in the multi-stent group (MSG). PMI occurred more frequently in the MSG than in the SSG (16.7% vs. 7.9%, p = 0.045). Compared with the SSG, the MSG had fewer single-vessel lesions, more left circumflex artery involvement, and larger stent diameters, indicating greater lesion and procedural complexity. Multivariable logistic regression showed that both AMI (OR = 2.804, 95% CI: 1.122-7.010; p = 0.027) and a higher number of implanted stents (OR = 2.533, 95% CI: 1.012-6.340; p = 0.047) were associated with PMI. Multiple stent implantation during planned PCI is associated with a higher risk of PMI. Careful procedural planning may help reduce PMI incidence in patients with complex coronary anatomy.
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This meta-analysis aimed to systematically evaluate the incidence and risk of dizziness associated with novel endocrine therapies (androgen receptor pathway inhibitors, ARPIs) in patients with advanced prostate cancer. A comprehensive literature search was conducted across PubMed, Web of Science, and ClinicalTrials.gov databases. After screening titles/abstracts and full-texts, 4 eligible randomized controlled trials (RCTs) involving 4267 patients were included. Risk of bias assessment was performed using the Cochrane Risk of Bias (RoB 2) tool. Meta-analysis results indicated that ARPI-based therapy was significantly associated with an increased risk of all-grade dizziness (risk ratio [RR] = 1.60, 95% confidence interval [CI]: 1.28-2.00, I2 = 18.7%, p = 0.2955) compared with control. For grade ≥ 3 dizziness, the pooled RR was 2.03 (95% CI: 0.56-7.29, I2 = 0.0%, p = 0.8165), though statistical significance was not reached. Subgroup analyses by ARPI type (abiraterone [Abi], Abi + enzalutamide [Enz], darolutamide [Dar], Enz) showed no significant differences in dizziness risk among subgroups (p = 0.2026). In conclusion, novel endocrine therapy with ARPIs increases the risk of all-grade dizziness in prostate cancer patients, while the risk of severe dizziness remains non-significant. Clinicians should monitor dizziness symptoms during ARPI treatment to optimize patient management.
The increasing prevalence of diabetes mellitus (DM) and prediabetes (Pre-DM) in elderly individuals necessitates refined diagnostic tools. The oral glucose tolerance test (OGTT) is cumbersome, and age may alter glycemic parameters, suggesting a need for age-specific thresholds. This study aimed to evaluate the diagnostic performance of glycated hemoglobin (HbA1c) and glycated albumin (GA) for dysglycemia in community-dwelling older adults in Chengdu, China. This was a community-based cross-sectional study that consecutively enrolled eligible community-dwelling residents aged 60 years or older in Chengdu, China. A total of 1,162 participants underwent measurements of fasting plasma glucose (FPG), HbA1c, and GA. A standard 75‑g oral glucose tolerance test (OGTT) with two‑hour post-prandial plasma glucose (2hPG) measurement was performed, and glycemic status was defined according to the World Health Organization (WHO) diagnostic criteria. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cutoff values for HbA1c and GA to detect DM and Pre-DM. Among the 1,162 participants (65.2% were female; median age, 67 years), 38.2%, 34.5%, and 27.3% were classified as having normal glucose tolerance (NGT), Pre-DM, and DM, respectively. For the diagnosis of DM, HbA1c demonstrated an AUC of 0.86 (95% CI: 0.83-0.88). An optimal cutoff value of 6.0% yielded greater sensitivity (72.56%) than did the conventional threshold of 6.5% (sensitivity: 34.70%), while maintaining a specificity of 85.36%. Diagnostic performance was superior in females than in males (AUC = 0.87 vs 0.83, P = 0.001) and varied significantly across age and BMI groups, supporting the consideration of age‑specific cutoff values. GA demonstrated moderate diagnostic performance (AUC = 0.70), and its combination with HbA1c did not improve performance. Both biomarkers exhibited limited ability for identifying Pre-DM. HbA1c at a lower cutoff value of 6.0% demonstrated high diagnostic accuracy for DM in older adults, though its performance was influenced by age, sex, and BMI. In contrast, GA did not confer a significant diagnostic advantage. These findings suggest that the current cutoff value of HbA1c warrants reassessment in elderly individuals while also highlighting its limitations for Pre-DM screening, where OGTT may still be necessary. The trial was registered with the Chinese Clinical Trial Registry (https://www.chictr.org.cn, ChiCTR2300070831) on 24 April 2023.