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.
Pulmonary hypertension (PH) is highly prevalent and associated with increased mortality in patients undergoing maintenance hemodialysis (MHD). This study aimed to explore the disparities in the prevalence, risk factors, and prognostic impacts of PH between non-elderly and elderly MHD patients. This study included 179 MHD patients with complete clinical records. All patients were evaluated using Doppler echocardiography, and PH was defined as a pulmonary artery systolic pressure > 35 mmHg. The prevalence rates of PH were 24.8% in non-elderly patients and 33.8% in elderly patients. Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) was a predominant risk factor for PH in hemodialysis patients. A lower ratio of uric acid to high-density lipoprotein (UHR) was associated with PH among non-elderly patients, whereas diabetes mellitus served as a specific risk factor for elderly patients. The areas under the receiver operating characteristic curves of these risk factors identified in non-elderly and elderly patients were 0.86 (bootstrap 95% confidence interval (CI) 0.78-0.93) and 0.90 (bootstrap 95% CI 0.82-0.97), respectively. During a median follow-up duration of 32.90 (4.00-61.50) months, the presence of PH notably elevated the risk of all-cause mortality and cardiovascular hospitalization in both non-elderly and elderly patients. Meanwhile, it significantly augmented the risk of all-cause hospitalization (HR: 2.24, 95% CI 1.26-3.98, P = 0.006) in the non-elderly. Distinct risk profiles for PH were identified between non-elderly and elderly MHD patients, offering valuable clinical data for the development of early detection and prevention strategies based on age stratification.
There is a clear need for more effective screening tools for patients undergoing hemodialysis, especially considering the wide variation in depression screening options and the lack of a gold standard assessment tool for this specific population. This study aims to examine the validity and reliability of the Turkish version of the Depression Inventory for Maintenance Hemodialysis Patients (DI-MHD). This was a methodological study of the translation, cultural adaptation, and psychometric validation of the DI-MHD. Two hundred eighty-three patients from two hemodialysis units in Turkey were recruited for the study using convenience sampling. The following data were collected from the participants: descriptive characteristics, DI-MHD scores, Beck Depression Inventory (BDI) scores, and inflammatory biomarkers. The BDI was used as a reference instrument to evaluate the concurrent validity of the DI-MHD. Exploratory and confirmatory factor analyses were implemented to test the construct validity. The test‒retest method was used to test the reliability and consistency of the scale over time. IBM SPSS version 22.0 and AMOS 24.0 were used for analysis. Exploratory factor analysis revealed a dominant single factor explaining 37.21% of the total variance (extracted variance = 33.52%). Although confirmatory factor analysis demonstrated acceptable fit for the correlated four-factor and second-order models, high latent factor correlations (φ = 0.677-1.052) and strong higher-order loadings (0.708-1.041) indicated limited discriminant validity among dimensions. Therefore, the one-factor model was retained as the most parsimonious and theoretically coherent solution. The Turkish version of the DI-MHD is a valid and reliable tool that can be used to evaluate and classify the depression levels of patients in hemodialysis units. ClinicalTrials.gov NCT. First registration date: 2025-02-20.
Chronic kidney disease (CKD) affects thyroid metabolism, increasing the risk of hypothyroidism and hyperthyroidism. Dialysis further alters hormone levels through impaired synthesis, iodine imbalance, and treatment-related factors. This study aimed to evaluate the prevalence and incidence of hypothyroidism and hyperthyroidism in patients with CKD on dialysis. We conducted a search in the Scopus and PubMed databases up to November 29, 2024. We included studies reporting prevalence or incidence data on hypothyroidism or hyperthyroidism (clinical or subclinical) in CKD patients on dialysis (hemodialysis or peritoneal dialysis). A random-effects model meta-analysis of proportions was used to calculate pooled prevalence estimates. A total of 39 studies were included, with sample sizes ranging from 40 to 8840 participants. The prevalence of hypothyroidism was 15.9% (95% CI: 13.0 to 19.0; I²: 96.2%), with 5.6% for clinical hypothyroidism and 11.2% for subclinical hypothyroidism (notably higher in peritoneal dialysis). The prevalence of hyperthyroidism was 5.1% (95% CI: 2.7 to 8.2; I²: 93.8%), with 0.9% for clinical hyperthyroidism and 3.3% for subclinical hyperthyroidism. Meta-regression analyses indicated that a longer mean duration on dialysis was associated with a lower prevalence of hypothyroidism (p = 0.008). Only one study reported the incidence of hypothyroidism (10.9%) and hyperthyroidism (4.9%), thus evidence on incidence remains scarce. The prevalence of hypothyroidism and hyperthyroidism in patients with CKD on dialysis is high, although with high heterogeneity among studies. Evidence on incidence remains limited and should be interpreted as exploratory. These findings support increased clinical vigilance and consideration of early detection strategies rather than definitive screening policies.
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.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
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.
暂无摘要（点击查看详情）
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.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
Social media platforms are widely used by medical students not only for personal communication but increasingly for educational purposes. Despite this trend, evidence on structured integration of social media into medical curricula remains limited. This study explores the use of Instagram as a supplementary asynchronous teaching tool in hematology and medical oncology. An Instagram account was created to complement the hematology and oncology teaching module. Educational content was disseminated through posts and interactive, case-based stories. Posts were categorized into five themes: 'knowledge', 'media', 'work-life balance', 'patient care', and 'other'. Engagement rate served as a proxy for student interest. Interactive features such as polls, quizzes, and multiple-choice questions were employed to promote participation. Student interaction was quantified by story views relative to total followers. A survey was conducted at the end of the module to evaluate student perceptions. Posts related to 'work-life balance' achieved the highest engagement, while other categories showed no significant difference in interaction. Case-based Instagram Stories were viewed by an average of 48.9% (± 7.3%) of followers, indicating consistent student engagement. Case length did not affect participation. Among interaction formats, multiple-choice questions were preferred. In the final evaluation, 98.4% (60/62) of respondents rated the case-based learning approach via Instagram Stories as good or very good, and 93.2% (55/59) rated the "ilearnonco" Instagram account as a good or very good educational tool. Instagram can be effectively integrated into a medical curriculum to support asynchronous, case-based learning in hematology and oncology. The high acceptance and engagement rates highlight the potential of social media as a complementary educational resource in medical education.
暂无摘要（点击查看详情）
Human nephrogenesis is complete at 34-36 weeks gestation, with 60% of nephrons forming during the third trimester through lateral branch nephrogenesis (LBN). Currently, no mechanism exists for LBN as there are no late gestation human kidney transcriptional datasets. We hypothesized that an induced but dividing population of nephron progenitor cells (NPCs) would contribute to the amplification of nephrons in late gestation. We used the rhesus macaque, an established model of LBN, to help identify potential mechanisms. Single-cell RNA-sequencing (scRNA-Seq) was performed on cortically-enriched fetal rhesus kidneys (n = 9) from late second trimester and third trimester during LBN. This data was integrated with publicly available human scRNA-seq datasets from 8-18 weeks gestation kidneys (n = 8) using Harmony package. Differentially expressed genes and ligand-receptor interactions were assessed and validated using RNAScope™ on human and rhesus archival tissue. Label transfer of previously defined kidney cell populations was performed on scRNA-seq data from 64,782 rhesus cells, including 7,879 nephron progenitor cells (NPCs) identified based on marker gene expression. Pseudotime analyses identified a late gestation-specific lineage branch of induced NPC in rhesus that was not observed in mid-gestation humans. Differential expression analyses identified increased SFRP1, FZD4, and TLE2 and decreased FZD7, SHISA2, SHISA3, and TLE4 within the late-gestation rhesus NPC compared to mid-gestation human NPC and increased SEMA3D within the rhesus ureteric bud (UB) tip, suggesting a compositional shift in WNT and SEMA signaling components within the naive NPC population during LBN. The rhesus macaque uniquely enables molecular studies of late-gestation primate nephrogenesis. Our study suggests the hypothesis that a transitional state of self-renewing NPCs supported by compositional shifts in key pathways may underlie the switch from branching phase nephrogenesis to lateral branch nephrogenesis and support ongoing nephron formation in late gestation. However, it remains to be determined if these changes within the late gestation NPC are time-dependent or species-dependent.
Data on infectious complications associated with biologic therapies in tropical settings are scarce. French Guiana, an Amazonian French overseas territory, combines an important burden of infectious diseases with a high use of biologic therapies. Our objective was to assess the incidence, spectrum, and risk factors for infections in patients treated with biotherapies for inflammatory and autoimmune diseases in French Guiana. We performed a multicentre retrospective study of adult patients receiving biotherapies between January 2021 and December 2023 in the French Guiana University Hospital (including its main site in Cayenne, its three local hospitals and 15 remote health centres). The primary outcome was the occurrence of any infectious event. Secondary outcomes included the severity of infection and identification of clinical and epidemiological risk factors. 146 patients (mean age 44.1 years, 61.6% female) were included. 48.0% of patients included had at least one infectious event. Most infections were mild (90.4%) and significantly associated with concomitant immunosuppressants (35.7%) or with remote health centres follow-up (11.4%). The tropical context revealed a distinct epidemiology, with five cases of dengue fever, two cases of scabies and one histoplasmosis. The majority (55%) of events occurred under first-generation biotherapies (notably rituximab and anti-TNF agents). The most frequent type of infection was cutaneous (27.2%), particularly in patients with a dermatological indication. Biotherapies appear generally well tolerated in this tropical setting, but patients living in remote areas or with concomitant immunosuppressant therapies remain vulnerable. Specific awareness should be dedicated to secondary cutaneous infections in patients treated for dermatological indications. Not applicable.