Social determinants of health have been related with kidney diseases and their outcomes. Financial toxicity (FT) refers to the negative impact of health care costs on clinical conditions. This scoping review aimed to evaluate the literature linking FT with renal diseases. We Included all studies analyzing FT and renal disease recorded in PubMed, Embase and Google Scholar between 2013 and 2023. The research question was formulated with reference to the acronym PCC (Problem, Concept and Contest). For each included study, we considered the study design, the population and main results from different populations with distinct renal conditions and the results were summarized in four tables. Socioeconomic deprivation was the main cause of FT, and the majority of studies on the relationship between FT and chronic kidney disease (CKD) were conducted in the USA (4 studies evaluated the pediatric population and 6 studies included adults). Three studies reported the impact of FT on nephrolithiasis, and 3 studies analyzed the link between FT and renal tumors. The methods used for detecting FT differed and were based on consultations, questionnaires, expenditures and database records analysis. The COmprehensive Score for financial Toxicity (COST) questionnaire was used in 7 studies (43%), and the prevalence of FT was reported to be high in children and adults. Although the quality of the selected study is limited, due to different populations investigated and heterogeneity in detecting FT, the latter seems to be a frequent finding in people with renal disease. Health care professionals should recognize socioeconomic deprivation as the major cause of FT. Detecting FT could help in prioritizing patient-centered care in populations with renal diseases through the development of strategies aimed at improving care for people with kidney diseases. Social determinants of health, especially poverty, social environmental stressors and psychological factors, are increasingly recognized as significant determinants of kidney diseases and their outcomes. Financial toxicity (FT) refers to the negative impact of health care costs on clinical conditions. The relationship between FT and renal disease is not completely understood. With this scoping review, we evaluated all published papers between 2013 and 2023 on this item. We analyzed 16 studies and found that FT is common in pediatric and adult CKD patients and in patients with nephrolithiasis and renal tumors. For patients with kidney disease, FT represents a significant burden, both through the direct costs of disease management and treatment and through indirect costs such as the loss of income due to missed work and expenses for transportation and accommodations near outpatient clinics. Finally, it should be noted that in different countries, it is difficult for people with kidney disease to obtain health insurance coverage. Health care professionals need to improve their knowledge about the relationship between FT and renal disease; there is a paucity of data regarding the effects of FT on different outcomes, although this nonmedical risk factor can negatively influence kidney health and quality of life. Further studies involving different professionals able to consider environmental, physical and emotional risk factors are needed.
Limited data exist regarding treatment patterns and symptom burden of patients with anemia of chronic kidney disease (CKD) in the Middle East, South Africa, and Türkiye. This real-world study explored clinical characteristics, symptom burden, and treatment patterns of patients with anemia of CKD living in the Middle East, South Africa, and Türkiye. Physician and patient perceptions of treatment were captured via cross-sectional surveys; patients' clinical characteristics were recorded by retrospective review of medical records. Data were collected from 1788 patients and 217 physicians. A high proportion of patients had never received treatment for their anemia (n = 701, 39.2%); the most common treatment was erythropoietin-stimulating agents (ESAs) + intravenous iron (n = 457, 50.3%). High symptom burden was reported, with lack of energy being the most common symptom (n = 394, 75.6% treated and n = 133, 59.9% non-treated patients). Patients' self-reported symptom burden was higher than physician-reported burden; less agreement was seen for non-dialysis-dependent (NDD) patients (kappa = 0.193, standard deviation [SD]: 0.081) than dialysis-dependent (DD) patients (kappa = 0.442, SD: 0.103). Median hemoglobin thresholds that physicians reported using for initiating treatment (NDD: <10.5 [interquartile range, 9.5-12.0] g/dL; DD: <9.3 [9.0-10.0] g/dL) were higher than actual test levels at treatment initiation (NDD: 9.2 [8.7-10.0] g/dL; DD: 9.0 [8.1-10.0] g/dL). Treatment inertia is apparent despite high symptom burden in the Middle East, South Africa, and Türkiye, and disagreement was seen in physician and patient perspectives on symptomology. Improved awareness of this disagreement may help facilitate physician-patient dialogue to improve patient experience. A survey to understand the experiences of people living with anemia and kidney disease in the Middle East, South Africa, and Türkiye Background People living with kidney disease can have a low number of red blood cells (anemia). This can cause heart problems, make kidney disease worse, and lead to death.Not much is known about the experiences of people living with kidney disease and anemia in the Middle East, South Africa, and Türkiye. For example, what symptoms do they experience, and which treatments do they receive for their anemia? What we did We carried out surveys in the Middle East, South Africa, and Türkiye between June and September 2022. We surveyed 1788 people living with kidney disease and anemia, and 217 of their doctors.We asked about symptoms experienced by people living with kidney disease and anemia, and which treatments they received for their anemia. What we found People living with kidney disease and anemia experienced many different symptoms. Lack of energy was the most common.People living with kidney disease and anemia mentioned symptoms more frequently than their doctors. Almost 40% of people living with kidney disease did not receive any treatment for their anemia. The most common treatment was iron combined with drugs that increase production of red blood cells (erythropoietin-stimulating agents). What does this mean? To improve communication and care, doctors should be made aware of how much the symptoms of anemia affect the lives of people living with kidney disease. Disclaimer: This plain language summary represents the opinions of the authors. For a full list of declarations, including funding and author disclosure statements, and copyright information, please see the full text online.
Chronic kidney disease (CKD) is accompanied by systemic metabolic dysregulation, and metabolomics provides a robust approach for identifying disease-specific metabolic signatures and potential biomarkers. Hypertension may be closely associated with metabolic disturbances in CKD. This study aimed to characterize serum metabolic alterations and dysregulated pathways in CKD, and screen candidate metabolite biomarkers for distinguishing CKD patients from healthy individuals. A total of 65 participants (35 CKD patients and 30 healthy controls) were enrolled in this study. Serum metabolic profiling was performed using high-resolution mass spectrometry-based untargeted metabolomics, while targeted analysis of small molecule metabolites was conducted via liquid chromatography-mass spectrometry (LC-MS). Multivariate statistical analyses including principal component analysis (PCA) and orthogonal partial least squared-discriminant analysis (OPLS-DA) were applied to identify metabolic alterations between groups. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis was used to annotate the functional roles of differentially expressed metabolites. Independent t-tests and Pearson correlation analyses were performed to validate the expression and correlation of key metabolites. A total of 1,426 metabolites were detected in all serum samples, with 1,246 successfully identified by secondary mass spectrometry. Differential analysis revealed 397 significantly altered metabolites (216 up-regulated and 181 down-regulated) between the CKD and control groups. KEGG enrichment analysis indicated that these differential metabolites were mainly involved in phenylalanine metabolism, arginine and proline metabolism, and glutathione metabolism, suggesting systemic metabolic dysfunction in CKD. Targeted analysis of catecholamines showed that serum concentrations of adrenaline and nicotinamide mononucleotide (NMN) were significantly altered in CKD patients compared with healthy controls (P < 0.05), though no significant linear correlation was observed between these two metabolites and CKD progression via Pearson correlation analysis. The identified metabolic pathway dysregulations (amino acid metabolism and redox-related pathways) are core metabolic characteristics of CKD, which are closely associated with renal function impairment, oxidative stress and hypertension in CKD. Adrenaline and NMN may serve as potential candidate biomarkers for CKD, and their abnormal expression may be linked to the activation of the renin-angiotensin system and dysregulation of renal energy metabolism. However, the specific mechanistic roles of these two metabolites in CKD pathophysiology remain to be elucidated. This study comprehensively characterized serum metabolic alterations in CKD and identified key dysregulated metabolic pathways, as well as adrenaline and NMN as potential candidate biomarkers. These findings enhance the understanding of biochemical dysregulation underlying CKD and provide novel insights for future diagnostic biomarker development and targeted therapeutic exploration for CKD.
Chronic kidney disease (CKD) is an increasing public health challenge, affecting about 11% of adults worldwide. Kidney diseases are now the third fastest-growing cause of death globally, and the number of patients reaching end-stage kidney disease continues to rise, resulting in growing demand for renal replacement therapy. A variety of clinical and individual factors influence the management of the disease. However, meaningful patient participation in this process is only possible when patients possess adequate knowledge of their disease and treatment options. Patient education is therefore a fundamental component of CKD management. It promotes behaviors that improve disease control and slow disease progression, while empowering patients to actively engage in shared decision-making and enhancing quality of life. Although both Polish and international guidelines highlight the need for structured education and its integration into comprehensive care models, practical recommendations on how such programs should be organized remain scarce. This article presents an expert opinion based on clinical experience and current literature. The recommendations outline key principles for designing and implementing high-quality educational initiatives that can be applied across nephrology centers and tailored to different stages of CKD. They also provide a framework for establishing a nationwide nephrology education system built on best practices and evidence-based standards.
Congenital anomalies of the kidney and urinary tract (CAKUT) are a common cause of chronic renal disease and usually manifest either antenatally or in the early years of life. Solitary Kidney with Renal Dysplasia presents early in life due to regular antenatal sonographic scans. The rarity of diagnosis being deferred until adulthood has important implications when there is prematurity and other associated congenital anomalies, such as Congenital Heart Disease. We present a 23-year-old male experiencing sequential generalized edematous changes, decreased urine output, early feelings of fullness during meals, and vomiting following the intake of a meal for the last month. The patient was born prematurely at approximately seven months of gestation, and he was a twin, with the loss of the co-twin soon after birth. There was neither a previous chronic disease nor hospitalization. Physical evaluation showed the patient to be hypertensive with generalized edematous changes of the face and both lower limbs, along with systolic murmurs at the lower edge of the left sternal region. Laboratory findings indicated the presence of severe renal impairment with high serum creatinine and potassium, massive proteinuria, and severe anemia. Renal ultrasound revealed a small, echogenic right kidney compatible with chronic renal disease and an absent left kidney, confirming the suspicion of a solitary right dysplastic kidney. The cardiac study showed dilated cardiac chambers with an atrial septal defect, mild pericardial effusion, and the patient was placed on antihypertensive drugs and diuretics and started on hemodialysis. This is a rare adult presentation of solitary kidney and renal dysplasia in a prematurely born male twin, further compounded by atrial septal defect and end-stage renal disease. This report underscores the significant implications of these complications as a direct sequel to prematurity regarding the associated severe consequences for the subsequent renal and cardiovascular systems of these patients. Antenatal ultrasound scans play a crucial role in the early detection and management of such abnormalities.
Financial toxicity (FT) describes the strain individuals and families feel when they struggle with money due to medical expenses and related costs associated with their healthcare. Management of chronic kidney disease is expensive. The aim of this study was to detect FT in Italian patients undergoing renal replacement therapy. FT was investigated using the Patient-Reported Outcome for Fighting Financial Toxicity (PROFFIT) questionnaire in 238 individuals, of whom 147 (61.8%) received hemodialysis, 30 (12.6%) peritoneal dialysis, and 61 had renal transplantation (25.6%). The PROFFIT score was normalized to a 0-100% range, with 100% indicating the highest level of toxicity, and mean values were compared in the different groups of uremic patients stratified by age, sex and treatment. Mean age of the population was 66.2±13.7 years (range 23-89). The probability of FT due to financial distress in the whole population that was 42.1±24.1%, whilst mean probability of FT due to medical expenses response was 44.9±27.6%, mean probability of FT due to transportation response was 37.1±29.4% and mean probability of FT due to support from the Health System was 25.5±23.3%. FT was higher in the hemodialysis group. Hemodialysis patients showed worse financial burden than peritoneal dialysis and kidney transplanted patients, while peritoneal dialysis subjects felt better cared for by health care professionals than kidney transplanted individuals, however the latter group could afford monthly expenses better than hemodialysis patients. Health care professionals should discuss financial problems or other social challenges that may impact on the health of uremic individuals. Financial toxicity (FT) describes the harmful effect of high cost of medical treatment on people’s quality of life. Chronic disease management such as chronic kidney disease (CKD) can lead to substantial out-of-pocket prescription costs for patients, moreover CKD is often linked with poverty and other social determinants of health, including social environmental stressors and psychological factors. FT is usually investigated with questionnaires, and its impact could depend on the organization of the national health system. In Italy, a country with a fully public health-care system, the Patient-Reported Outcome for Fighting Financial Toxicity (PROFFIT) questionnaire was developed for investigating FT, and the latter was proposed to 238 individuals, of whom 147 (61.8%) received hemodialysis, 30 (12.6%) peritoneal dialysis, and 61 had renal transplantation (25.6%). FT was significantly present in the investigated cohort and hemodialysis patients showed worse financial burden than peritoneal dialysis and kidney transplanted patients, while peritoneal dialysis subjects felt better cared for by health care professionals than kidney transplanted individuals, however the latter group could afford monthly expenses better than hemodialysis patients. Younger hemodialysis individuals felt better than older ones, and the latter group spent more money on private medical examinations. Only in the items related to support from the health system patients answered that they agree substantially, whilst in all the other items they agree partially. FT should be considered by health care professionals due to its impact on patients’ wellbeing.
Secreted phosphoprotein 1 (SPP1), a glycoprotein encoded by the SPP1 gene, can be detected in body fluids and tumor tissues of various diseases, representing a promising candidate biomarker. However, its application in focal segmental glomerulosclerosis (FSGS) remains at the exploratory stage. In a small-scale cohort, Bulk-RNA sequencing was employed to screen for core differentially expressed genes in urinary cells of FSGS patients, with SPP1 identified as a key candidate. RT-qPCR and ELISA were subsequently used to detect SPP1 expression in clinical urine samples. An adriamycin (ADR)-induced FSGS mouse model was established, and renal histopathological changes were evaluated using hematoxylin-eosin (HE), periodic acid-Schiff (PAS), and Masson staining. Immunohistochemistry and immunofluorescence were performed to examine the expression of SPP1, fibronectin, and F4/80 in renal tissues, with assessment of the effects of prednisone intervention. Urinary SPP1 expression was significantly elevated in FSGS patients, particularly in those with CKD stage III. In the ADR mouse model, as glomerulosclerosis progressed, albuminuria levels increased, accompanied by enhanced expression of SPP1 and F4/80-positive macrophages. Prednisone treatment attenuated these parameters. SPP1 is involved in the progression of FSGS and is closely associated with renal immune inflammation and fibrosis. Prednisone exerts renoprotective effects by downregulating SPP1 expression and inhibiting macrophage infiltration, suggesting that SPP1 represents a promising molecular marker for disease monitoring and targeted intervention in FSGS.
Dialysis-requiring acute kidney injury (AKI-D) represents the most severe form of AKI and is associated with substantial morbidity. As survival after AKI-D improves, recovery following hospitalization has emerged as a critical but understudied phase of care. Whether recovery trajectories differ across sociodemographic groups and hospital contexts remains poorly understood. Dialysis-requiring AKI affects approximately 2-3% of hospitalized adults nationally and carries high post-acute morbidity, underscoring the importance of understanding recovery trajectories beyond survival. We conducted a retrospective, nationally representative study using the 2022 Healthcare Cost and Utilization Project National Inpatient Sample. Adult hospitalizations complicated by AKI-D among patients without pre-existing end-stage kidney disease who survived to discharge were included. The primary outcome was dialysis dependence or non-recovery at discharge, operationalized using discharge disposition as a pragmatic surrogate for post-acute recovery following receipt of acute dialysis. Survey-weighted logistic regression models adjusted for demographics, illness severity, and hospital characteristics were used to estimate adjusted odds ratios. Marginal standardization was applied to derive adjusted probabilities and absolute risk differences. Effect modification by hospital context was examined. Among survivors of dialysis-requiring AKI, approximately 40% were discharged to non-home settings, indicating a substantial burden of incomplete recovery at hospital discharge. After adjustment, adults aged ≥85 years had more than two-fold higher odds of non-recovery compared with those aged 50-64 years (adjusted OR 2.19), while self-pay patients had substantially lower odds compared with Medicare beneficiaries (adjusted OR 0.45). Patients with Medicaid or no-charge encounters-and several racial and ethnic minority groups-also exhibited lower adjusted probabilities of non-recovery. Hospital characteristics modified these associations, with payer-related differences in non-recovery varying by teaching status, bed size, and geographic region. Certain hospital settings exhibited both higher overall non-recovery burden and larger disparities. Sensitivity analyses using alternative outcome definitions and excluding patients with chronic kidney disease yielded consistent findings. Incomplete recovery at hospital discharge is common among survivors of dialysis-requiring AKI and is shaped by both patient-level vulnerability and hospital context. Institutional environments appear to modify recovery disparities, highlighting hospitals as potential leverage points for improving equitable post-AKI outcomes. Efforts to enhance recovery after AKI-D should extend beyond the acute hospitalization to address post-discharge transitions and system-level factors.
Chronic kidney disease (CKD) has become a significant public health burden in Europe, with marked spatiotemporal heterogeneity. Nitrogen oxides (NOx) and fine particulate matter (PM) are considered important environmental risk factors; however, the association of submicron particulate matter (PM1) with CKD mortality and the potential non-linear exposure-response patterns of these pollutants remain insufficiently characterized. In this ecological study, national-level aggregated data from 39 European countries from 1990 to 2022 were analyzed. Environmental exposure was assessed using population-density-weighted exposure estimates, and spatial heterogeneity was analyzed using a Geodetector approach. Linear mixed-effects models (LMM) and generalized additive mixed models (GAMM) were used to investigate the associations between environmental factors and age-standardized CKD mortality rates (ASMR). XGBoost, combined with SHAP interpretation tools, quantified the relative contributions and identified non-linear thresholds. Finally, a partial correlation network analysis revealed the interaction structures among environmental factors. After adjusting for confounders, NOx and particulate matter exposures showed significant positive correlations with CKD mortality risk. LMM revealed a pronounced "particle size effect": the coefficient for PM1 (β = 0.220 deaths per 100,000 population on the raw ASMR scale) was higher than that for PM2.5 (0.199) and PM10 (0.141). GAMM results supported the robustness of these associations on the logit-transformed proportional scale, and higher HDI was inversely associated with CKD mortality (βIQR = -0.056). XGBoost and LOESS analyses further revealed non-linear characteristics: particulate matter exposure exhibited an S-shaped saturation curve, whereas NOx exposure displayed a J-shaped threshold effect (with risk steeply increasing beyond 9 ppb). Network analysis indicated a strong positive correlation between high temperatures and CKD mortality (r = 0.42), whereas humidity was inversely correlated. Spatial detection further identified PM1 as the strongest explanatory factor of spatial variation in European CKD mortality rates (q = 0.243). Conversely, a higher Human Development Index (HDI) exhibited relatively robust protective effects against CKD mortality (β = -0.056). Our findings suggest that CKD mortality in Europe may be associated with NOx and fine PM (particularly PM1) exposure, which exhibit complex non-linear relationships. These findings support further evaluation of submicron particulate matter in environmental monitoring frameworks and suggest that transport-related pollution and heat-related climatic conditions warrant attention in strategies aimed at reducing regional CKD mortality disparities.
CIH, the hallmark of OSA, is a recognized driver of multi-organ injury. While its contribution to renal dysfunction is acknowledged, the specific roles of key senescence-regulating pathways-particularly the PI3K/Akt/p21 axis and the anti-aging protein Klotho-in CIH-induced renal senescence remain largely unexplored. This study aimed to investigate the effects of CIH and subsequent normoxic reoxygenation on renal senescence in rats, and to elucidate the dynamic involvement of the PI3K/Akt/p21 pathway and the anti-aging protein Klotho in this process. Forty 5-week-old male Sprague-Dawley rats were randomly assigned to NC and CIH groups. The CIH group was exposed to IH (range 6.5-7.5%, 30 cycles/h, 8 h/day) for 8 weeks, followed by a 4-week normoxic recovery period. Renal function (SCr, BUN,CysC), histopathology (cortex-to-medulla ratio, tubular epithelial density), and the expression of senescence-related molecules (p21, Klotho, PI3K/AKT pathway components) were assessed at weeks 0, 8, and 12. Statistical significance was determined by two-way ANOVA with Tukey's post hoc test. Following 8 weeks of CIH exposure, rats exhibited significant renal dysfunction, with SCr increased by 21.3%, BUN by 24.0%, and CysC by 27.9% compared to controls (all P<0.05), alongside histopathological alterations including cortical atrophy, medullary expansion, and reduced tubular epithelial density (P<0.05).These changes were associated with upregulation of p21 and downregulation of PI3K/AKT signaling and Klotho (P<0.05). After 4 weeks of normoxic recovery, renal function and PI3K/Akt/p21 signaling were largely restored (P>0.05 vs NC). However, cortical-medullary structural imbalance and suppressed Klotho expression persisted (P<0.05). Statistical significance was determined by two-way ANOVA with Tukey's post hoc test). CIH induces a partially reversible renal senescence phenotype in rats, which is associated with dynamic modulation of the PI3K/Akt/p21 axis. The persistent suppression of Klotho may underlie irreversible structural injury, providing novel mechanistic insights into OSA-associated kidney disease.
Chronic kidney disease (CKD) incidence continues to rise along with obesity and diabetes, driving substantial medical, psychosocial, and economic burdens for patients. Beyond glycemic control and the recommended therapies of ACEI/ARB, SGLT2 inhibitors and non-steroidal mineralocorticoid receptor antagonists, glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as a cornerstone therapy to benefit mortality, heart and kidney outcomes. The following review will discuss recent advances to our understanding of the kidney benefits of GLP1 agonism in high-risk populations, including patients with type 2 diabetes mellitus, obesity, those with established cardiovascular disease. Renal signals from cardiovascular outcomes trials disclosed less albuminuria and slower estimated glomerular filtration rate (eGFR) decline with GLP1RA therapy, often additive to sodium-glucose cotransporter-2 inhibition. Dedicated kidney studies now show semaglutide slows CKD progression and lowers mortality in diabetics with CKD, underscoring the relevance of new guidelines that recommend GLP1RA therapy for specific populations. Future priorities should include trials of GLP-1RA in non-diabetic patients with CKD, as well as further evaluation of dual or triple agonists (GLP-1/GIP/glucagon) and clarification of oral GLP1RA efficacy. Overall, GLP-1-based therapies represent a transformative strategy to improve weight, cardiovascular health, and kidney outcomes in diabetic CKD patients.
Unhealthy behaviors can accelerate the progression of chronic kidney disease (CKD). This study aimed to evaluate the effectiveness of a community-based integrated care program in modifying key unhealthy behaviors among CKD patients in rural Thailand and to assess the impact of these behaviors on the rate of kidney function decline. This is a post-hoc analysis of the ESCORT-2 trial, which is a 3-year prospective cohort study that enrolled 914 patients with CKD stages 3-4 in rural Thailand. Participants received an integrated care program involving hospital-based multidisciplinary teams and home-based community care networks. Seven unhealthy behaviors were assessed annually: usage of herbal medicines, analgesics, and non-steroidal anti-inflammatory drugs (NSAIDs); being overweight; lack of regular exercise; moderate-to-high salt intake; and high protein intake. Data were collected through patient interviews and standardized questionnaires. Changes in the prevalence of these behaviors were analyzed over three years, and the association between persistent unhealthy behaviors and the rate of eGFR decline was examined. Over the 3-year study period, the integrated care program led to significant and sustained reductions in the use of herbal medicines (23.3% to 5.0%), analgesics (34.9% to 7.8%), and NSAIDs (4.3% to 1.3%) (all p<0.0001). Moderate-to-high salt intake also significantly decreased (22.1% to 14.1%, p<0.0001). However, no significant improvement was observed in the prevalence of overweight or high protein intake. While individual persistent unhealthy behaviors did not significantly correlate with the rate of estimated glomerular filtration rate (eGFR) decline, patients with a baseline accumulation of three or more unhealthy behaviors exhibited a significantly faster eGFR decline compared to those with fewer unhealthy behaviors (-2.04 vs -1.02 mL/min/1.73 m², p<0.001). An integrated care model implemented in a primary care setting can effectively reduce medication- and dietary-related unhealthy behaviors in CKD patients. However, fostering sustained improvements in complex lifestyle behaviors such as weight control and regular exercise remains a significant challenge.
This study seeks to highlight the impact of clinical pharmacists in protecting hemodialysis patients from catheter-related infections. By ensuring appropriate antimicrobial use, guiding patients on prevention practices, and collaborating with the healthcare team. This study also examines how pharmacists improve safety, treatment adherence, and quality of life. This randomized interventional study was conducted between November 2024-April 2025. Patients were divided into intervention and non-intervention groups. The care bundle comprised culture-guided antibiotic locks (except gentamicin-heparin), in-hospital exit-site dressing with 3M Tegaderm by trained staff, and safety medication checks (e.g, blood-pressure monitoring before the use of erythropoiesis-stimulating agents) were used. The primary endpoint was the incidence of catheter-related bloodstream infections (CRBSIs); secondary endpoints were length of stay, admissions, ICU admissions, catheter replacements, and death. Monthly averages of vitals, drug therapy problems (DTPs), and laboratory parameters were obtained for both groups. A total of ninety patients included in this study. The patients were randomly assigned to either the intervention or non-intervention group and a total 81 out of 90 patients successfully completed the study. After four visits and six months of implementing infection control measures within the context of pharmaceutical care, the infection rate showed a significant reduction in the intervention group (from 0.64±0.48 to 0.20±0.4, p =0.0001) compared with the non-intervention group (0.66±0.48 to 0.71±0.45, p =0.9731). The mean differences increased over time, reaching 0.26 (95% CI of diff.= 0.09 to 0.43) at visit 1, 0.41 (95% CI of diff.= 0.24 to 0.58) at visit 3, and 0.51 (95% CI of diff.= 0.34 to 0.68) at visit 4. Clinical pharmacist intervention via implementing infection control within the context of a pharmaceutical-care process can improve infection rates among hemodialysis patients.
Adherence to treatment regimens is crucial to enhance the clinical outcomes of patients with End-Stage Renal Disease (ESRD). In Yemen, there is a gap in information about this issue. Hence, this study aimed to assess the adherence and associated factors of ESRD patients to the four adherence domains, including HD session attendance, medication, dietary modification, and fluid management. A descriptive cross-sectional study of ESRD patients was conducted. End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) was used to collect data through face-to-face interviews. The scoring system was used. The mean of the gained scores was calculated and divided by expected maximum scores and the resulting percentage was used to rank the level of adherence as good ≥ 83%, moderate ≥58- <83% and poor <58%). Non-parametric tests to assess the mean differences with selected variables at p-value <0.005. The overall (mean ±SD) scores of 393 patients for the four adherence domains (HD, medication, fluid restrictions, and dietary recommendations) were 933.5+210 indicating an overall moderate level of adherence. Good adherence to HD and moderate adherence to medication, diet and fluids were observed (88.5%, 76.7%, 61.9%, and 61.6%, respectively). Significantly higher mean scores among patients with urban residency (941.8 vs 869.4, p=0.03), HD duration < 5 years (949.2 vs 908.0, p=0.02), the overall perception of treatment (956.7 vs 653.3, p=<0.001), patients who had a perception of medication (942.0 vs 734.3, p=0.002), fluid restriction (958.9 vs 727.3, p=<0.001), and diet recommendations (969.8 vs 715.2, p=<0.001). Significantly lower mean scores were observed among patients who had not received counseling regarding the importance of dietary and fluid restriction (962.8 vs 920.5, p=0.02) and (965.6 vs 919.0, p=0.02, respectively). This study is the first in our country to provide baseline information on adherence toward different treatment domains and their associated factors among patients with ESRD. The adherence level among patients with ESRD was moderate in general and good for HD. There was a significant association between adherence and residency, HD duration, overall perception of treatment, perception of medication, fluid and dietary restrictions, and poor counseling. Regular counseling should be provided to enhance adherence levels. A multicenter study is recommended to assess the causal relationship between adherence and the factors affecting adherence.
This study aims to evaluate the diagnostic efficacy of shear wave elastography (SWE) and super-resolution imaging (SRI) in detecting moderate-to-severe renal fibrosis (MSRF) among patients with chronic kidney disease (CKD). In this prospective study, 202 CKD patients who underwent SWE and SRI prior to renal biopsy were enrolled. Based on pathological findings, patients were categorized into a mild renal fibrosis group (n=107) and an MSRF group (n=95). LASSO logistic regression was employed to identify independent risk factors for MSRF. Four diagnostic models-isolated, series, parallel, and integrated-were developed by combining elasticity values from SWE and vascular density values from SRI. Additionally, a nomogram incorporating clinical parameters and ultrasound composite parameters was constructed to assess MSRF in CKD patients. LASSO and subsequent logistic regression analysis revealed that age, diabetes history, estimated glomerular filtration rate (eGFR), elasticity, and vascular density were independently associated with MSRF. The integrated model, utilizing a logistic algorithm, demonstrated superior diagnostic performance with an area under the curve (AUC) of 0.83 (P < 0.001), sensitivity of 80.4%, and specificity of 75.8%, outperforming all other models. Furthermore, the nomogram, which integrated clinical factors and ultrasound composite parameters, exhibited excellent predictive performance (AUC = 0.878, 95% CI 0.782-0.974). Calibration and decision curve analyses confirmed the model's robust calibration and clinical utility. The integration of SWE-derived elasticity and SRI-derived vascular density significantly enhances the diagnostic accuracy for MSRF in CKD patients. This comprehensive approach offers a promising non-invasive strategy for assessing renal fibrosis severity.
Chronic kidney disease (CKD) is a major global health concern worldwide. CKD has become a major health concern in the Kingdom of Saudi Arabia (KSA) owing to rising rates of diabetes and hypertension. This study aimed to evaluate the knowledge and competence of healthcare professionals in KSA regarding CKD management, focusing on aspects such as screening, diagnosis, complications, and treatment, based on the latest evidence-based guidelines. A cross-sectional study was conducted among healthcare professionals involved in management of patients with CKD and DM patients in the KSA. The duration of the study was six months, that is, September 1, 2024, to February 28th, 2025. A validated self-administered questionnaire was used to assess the participants' confidence in different aspect of CKD management. The data was analyzed using descriptive statistics, the relative importance index (RII) and univariate binary logistic regression to identify factors associated with higher confidence using SPSS. A total of 391 healthcare professionals were included in this study. Among the healthcare professionals recruited, 54.0% were age group-28-37 years and 52.2% were pharmacists. The regression analysis showed diabetologists demonstrated the highest confidence in selecting appropriate CKD management (OR = 9.78, 95% CI: 2.39-39.96, p = 0.002), 5.16 times higher odds for understanding ACE-Is/ARBs (OR = 5.16, 95% CI 1.40-19.10, p = 0.014), and 6.09 times higher odds for initiating newer agents for diabetic kidney disease (OR = 6.09, 95% CI: 1.67-22.30, p = 0.006). Confidence increased progressively with professional experience, particularly among those with 3-4 years (OR = 5.14, 95% CI 1.63-16.25), 7-8 years (OR = 8.40-14.58, 95% CI 2.46-54.81), and 9-10 years (OR = 11.25-15.87, 95% CI 2.52-78.32; p < 0.01). Confidence in CKD management among healthcare professionals in Saudi Arabia was variable and influenced by professional role and experience. Diabetologists and those with 3-10 years of experience reported significantly higher confidence. These findings underscore the need for targeted educational interventions to strengthen CKD management confidence and capacity among primary care professionals.
The prevalence of insomnia among patients with end-stage kidney disease undergoing hemodialysis is high. Insomnia in patients undergoing hemodialysis may reduce their quality of life. The purpose of this study was to estimate the prevalence of insomnia and to examine the risk factors associated with insomnia among patients with end-stage kidney disease undergoing hemodialysis. This cross-sectional study included 216 patients with end-stage kidney disease undergoing hemodialysis at 175 Military Hospital, Ho Chi Minh City, Vietnam. Psychiatrists evaluated insomnia using clinical criteria of The Diagnostic and Statistical Mental Disorders, 5th Edition (DSM5). Participants were recruited using convenience sampling at 175 Military Hospital in Vietnam, with all eligible patients invited. Descriptive statistics (counts, percentages, means, standard deviations) were used to describe population characteristics and insomnia prevalence. Data were collected on patients' sociodemographic factors such as sex, age, marital and economic status; clinical factors including duration of end-stage kidney diseases, duration of hemodialysis, number of hemodialysis sessions per week, co-morbidities (diabetes, hypertension…) and environmental factors (eg, excessive noisy or light bedrooms). Logistic regression analysis model was used to analyze the factors associated with insomnia disorders in patients with end-stage kidney disease undergoing hemodialysis. The prevalence of insomnia among patients with end-stage kidney disease was 48.1%. Multivariate logistic regression showed diabetes (OR=0.331 for no diabetes, 95% CI: 0.148-0.738, p<0.01), daytime napping (OR=2.122, 95% CI: 1.159-3.885, p=0.02, excessive noisy or light bedrooms (OR=0.251 for no exposure, 95% CI: 0.074-0.854, p=0.03) were significantly associated with insomnia. The prevalence of insomnia in patients with end-stage kidney disease was high. These results may help clinicians in the dialysis department pay more attention to insomnia symptoms in patients with end-stage kidney disease on dialysis and consider collaboration with psychiatrists to explore treatment strategies is also recommended.
Haemodialysis (HD) is the predominant kidney replacement therapy for end-stage kidney disease (ESKD) in Indonesia, whereas continuous ambulatory peritoneal dialysis (CAPD) is less frequently used. Hypertension is highly prevalent in this population and may impair health-related quality of life (HRQoL). This study aimed to compare HRQoL between HD and CAPD patients using the EQ-5D-5L instrument. A prospective observational cohort study was conducted at Dr. Hasan Sadikin General Hospital, Bandung (September 2023-January 2024). Adults with ESKD and hypertension on HD or CAPD for ≥3 months were assessed at baseline, week 2 and week 4 using EQ-5D-5L and EQ-VAS. Socio-demographic and clinical data were obtained from medical records. Baseline differences were examined using χ2/Fisher's exact and Mann-Whitney U-tests. Longitudinal changes in EQ-5D-5L utility and EQ-VAS were analysed using linear mixed-effects models (LMMs) with random intercepts and fixed effects for time, dialysis modality, age and comorbidity; age×comorbidity and time×comorbidity interactions were explored. Ninety-one patients were included (58 HD, 33 CAPD). Compared with HD, CAPD patients were younger, more highly educated, more often insured through non-PBI schemes, and had greater comorbidity burden, more frequent use of ≥3 antihypertensive drugs and higher rehospitalisation rates. Mean EQ-5D-5L utility and EQ-VAS scores were similar between modalities at all time points. In LMMs, neither modality nor time showed significant main effects on EQ-5D-5L utility or EQ-VAS (all p>0.05). For utility, significant age×comorbidity (p=0.002) and time×comorbidity (p=0.032) interactions indicated less favourable trajectories among older, multimorbid patients. After accounting for repeated measurements and baseline confounding, short-term overall HRQoL appeared broadly comparable between HD and CAPD. Small numerical advantages for CAPD and the interaction patterns observed in LMMs should be considered hypothesis-generating and require confirmation in larger, methodologically robust studies.
Patients with chronic kidney disease (CKD) and coronary artery disease (CAD) had a poor prognosis. Indicators derived from complete blood count (CBC), like neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), Systematic Inflammation Response Index (SIRI), systemic immune-inflammation index (SII) and Pan-Immune-Inflammation Value (PIV) had prognostic significance. But which one performed best in patients with CKD and CAD was still unclear. CKD Patients with CAD admitted to ICU were retrospectively included. Patients with sepsis, connective tissue disease, tumor and receiving glucocorticoids were excluded. The primary endpoints encompassed in-hospital mortality and 30-day mortality. The study comprised 694 participants, with 60 patients died during hospitalization, and another 15 died in 30-day follow-up period. Both the admission level and maximal level of CBC-derived indicators were higher in the deceased group. ROC curve analysis demonstrated that maximal NLR had the highest AUCs - 0.795 for in-hospital mortality and 0.754 for 30-day mortality prediction. Furthermore, Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) analyses further confirmed that adding maximal NLR to the base model, which included traditional risk factors, significantly improved both NRI and IDI (p < 0.05 for both). The maximum of NLR was with the best predictive value for in-hospital mortality and 30-day mortality in ICU patients with CAD and CKD. Predicting prognosis based on dynamic changes of NLR is more worthy of attention.
Chronic kidney disease-associated pruritus (CKD-aP) is a frequent and distressing problem for individuals with chronic kidney disease (CKD) and end-stage renal disease. It affects around 20% of those with CKD and 40% of those with end-stage renal disease. Despite its clear association with poorer psychosocial and medical outcomes, it is often underreported by patients and frequently remains unnoticed by healthcare providers. This is likely due to uncertainty regarding its diagnosis and treatment. Most commonly, CKD-aP could be screened with questionnaires like the KDQoL-36 and WI-NRS, chosen for their simplicity and ease of use. Prior treatment studies of CKD-aP were mostly limited by noncontrolled design and small sample size. First CKD-aP medication - difelikefalin a powerful, new therapeutic option was approved by Federal Drug Administration (FDA) in 2021 and European Medicines Agency (EMA) in 2022. Recent expert opinions, clinical trials and metanalysis identified difelikefalin and gabapentinoids as medications of choice in treatment of CKD-aP. All these findings improved current understanding and management of this condition.