Better evaluation of the contribution of the main diseases, injuries, and risk factors for mortality and life expectancy is crucial for more efficient policy making at the national and subnational levels in Iran. The aim of this study is to assess the effect of emerging causes of mortality on health, specifically COVID-19, which can help policy makers implement preventive measures in similar situations. In this systematic analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we present estimates of cause-specific mortality at the national and subnational levels in Iran from 1990 to 2023. New to this iteration of GBD, we present a decomposition analysis of the contribution of specific causes of death to net gain or loss in life expectancy across 31 provinces of Iran. We used an array of data sources including censuses, vital registration, and surveys for national and subnational estimates. The two leading causes of death in Iran were ischaemic heart disease and stroke in both 1990 and 2019. However, in 2020 and 2021, the COVID-19 pandemic displaced the leading causes of death, ranking first with age-standardised mortality rates of 286·2 deaths (95% uncertainty interval 267·9-310·5) per 100 000 in 2020 and 250·0 deaths (233·2-272·5) per 100 000 in 2021. COVID-19 ranked second and tenth in 2022 and 2023, respectively. Life expectancy at birth for both sexes combined declined from 78·0 years (77·7-78·1) in 2019 to 74·3 years (74·0-74·4) in 2020. It steadily recovered to 78·8 years (78·5-79·2) in 2023. COVID-19 was the main cause of loss in life expectancy, by 4·19 years, between 2019 and 2020. There was a net gain of 12·4 years in life expectancy in Iran from 1990 to 2023. The net gain at the national level can be mostly attributed to reduced mortality from ischaemic heart disease (2·61 years), stroke (1·63 years), neonatal disorders (1·26 years), transport injuries (0·88 years), and neoplasms (0·64 years). The decline in mortality rates of major causes continued to 2023 despite the pandemic. An exception was Alzheimer's disease, which showed a 4·0% increase in rate between 2019 and 2023 and led to a net loss of 0·04 years in life expectancy since 1990. Diabetes led to a net loss of 0·09 years since 1990. There were variations between provinces in terms of age-standardised rates and the net change in life expectancy before and after the COVID-19 pandemic. The COVID-19 pandemic disrupted the rising trend of life expectancy in Iran, varying across provinces. Findings show that the health-care infrastructure and policies in Iran were not efficient in controlling the pandemic in 2020 and 2021, mainly due to inadequate vaccination coverage and timeliness, specifically for vulnerable subgroups. Sanctions may have aggravated the effect of COVID-19 on loss in life expectancy of Iranians. Despite the pandemic, the declining trend in age-standardised rates for top causes of mortality has continued to 2023, leading to a full recovery of life expectancy and underscoring the ultimate resilience of Iran's health system. Gates Foundation.
Chronic kidney disease (CKD) is a public health issue, with an estimated prevalence of 10% in Brazil, possibly underestimated due to regional inequalities and diagnostic limitations. The EPI-CKD Brazil study aimed to estimate the prevalence of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 in adults with risk factor for CKD, using point-of-care creatinine testing (POCTcr) during World Kidney Day 2025, and to assess regional variations and associated predictors. We conducted a multicenter cross-sectional study across 20 state chapters of the Brazilian Society of Nephrology, including individuals ≥ 18 years with at least one CKD risk factor (age > 60 years, hypertension [HTN], diabetes mellitus [DM], cardiovascular disease, obesity, chronic use of nonsteroidal anti-inflammatory drugs, history of acute kidney injury, bilateral kidney stones, or family history of CKD). Renal function was assessed using a rapid creatinine test (NovaMaxPro®-eGFR CKD-EPI 2021). Reduced eGFR was defined as < 60 mL/min/1.73 m2. We analyzed 8,374 participants (66.9% women; median age, 58 years; BMI, 28.3 kg/m2; 46.2% mixed race). The frequency of reduced eGFR was 40.2% (n = 3,370), of whom 36% were in stages G3b-G5. Only 35.2% were aware of CKD risk factors. Significant regional differences were observed (ranging from 27.9% [Bahia] to 55.2% [Paraná]; p < 0.001). Independent predictors included age (OR = 1.032; 95%CI: 1.028-1.035), HTN (OR = 1.27; 95%CI: 1.15-1.40), and indigenous ethnicity as a protective factor (OR = 0.40; 95%CI: 0.20-0.89; p < 0.05). Risk increased by 23% for each additional risk factor. A high frequency of reduced eGFR and low awareness of CKD risk factors were observed. The study demonstrates the feasibility of POCTcr in screening strategies and reinforces the need for public policies to expand early diagnosis and strengthen primary care. A Doença Renal Crônica (DRC) é um problema de saúde pública, com prevalência estimada em 10% no Brasil, possivelmente subestimada por desigualdades regionais e limitações diagnósticas. O estudo EPI-DRC Brasil teve como objetivo estimar a prevalência de taxa de filtração glomerular estimada (TFGe) <60 mL/min/1,73m2 em adultos com fatores de risco, por meio de triagem com teste rápido de creatinina (POCTcr) durante o Dia Mundial do Rim/2025, além de avaliar variações regionais e preditores associados. Estudo transversal multicêntrico, realizado em 20 regionais da Sociedade Brasileira de Nefrologia, incluindo indivíduos ≥18 anos com pelo menos um fator de risco para DRC (idade >60 anos, hipertensão (HA), diabetes (DM), doença cardiovascular, obesidade, uso crônico de anti-inflamatórios não esteroidais, histórico de injúria renal aguda, litíase renal bilateral ou história familiar de DRC). A função renal foi avaliada pelo teste rápido de creatinina (NovaMaxPro®-TFGe CKD-EPI 2021). Considerou-se TFGe reduzida quando <60 mL/min/1,73m2. Analisamos 8.374 participantes (66,9% mulheres; mediana 58 anos; IMC 28,3kg/m2; 46,2% pardos). A frequência de TFGe reduzida foi 40,2% (n = 3.370), 36% estágios G3b–G5. Apenas 35,2% conheciam fatores de risco para DRC. Houve diferenças regionais significativas (de 27,9% [Bahia] a 55,2% [Paraná]; p < 0,001). Preditores independentes incluíram: idade (OR = 1,032; IC95%: 1,028–1,035), HA (OR = 1,27; IC95%: 1,15–1,40) e, como fator protetor, etnia indígena (OR = 0,40; IC95%: 0,20–0,89), p < 0,05. O risco aumentou 23% a cada fator de risco adicional. Observou-se elevada frequência de TFGe reduzida e baixo conhecimento sobre fatores de risco para DRC. O estudo demonstra a viabilidade do POCTcr em estratégias de rastreamento e reforça a necessidade de políticas públicas para ampliar o diagnóstico precoce e fortalecer a atenção primária.
Evidence on the drug effect of sodium-glucose cotransporter-2 inhibitors (SGLT2is) on mortality in patients with diabetic kidney disease (DKD) remains limited. We analyzed patients with DKD newly prescribed SGLT2is using large-scale Asian real-world data. We utilized commercially available databases provided by DeSC Healthcare, Inc., between 2014 and 2023. All-cause mortality was compared across five pairs of new users of SGLT2is-canagliflozin, empagliflozin, ipragliflozin, luseogliflozin, or tofogliflozin-each versus dapagliflozin, using a target trial emulation framework with propensity score matching. Among 12,308 patients with DKD, 1,553 new users of canagliflozin, 2,948 of empagliflozin, 1,672 of ipragliflozin, 931 of luseogliflozin, and 955 of tofogliflozin were matched 1:1 with corresponding new users of dapagliflozin. The mean age of participants ranged from 72.2 to 75.4 years, and 67.4-72.2% were men. During a median follow-up period of 1.12-1.96 years, the incidence of all-cause mortality among new users of SGLT2 inhibitors ranged from 32.3 to 46.2 for dapagliflozin, and was 28.8 for canagliflozin, 38.8 for empagliflozin, 33.4 for ipragliflozin, 33.8 for luseogliflozin, and 25.7 for tofogliflozin, per 1,000 person-years. Both the cumulative incidence and hazard ratios for all-cause mortality were comparable among new users of each SGLT2i compared with dapagliflozin (all log-rank P > 0.05; 95% CIs included 1). Comparable effects of SGLT2is on all-cause mortality risk were observed in patients with DKD using the Asian real-world data. This apparent class effect on all-cause mortality suggests that different agents may confer comparable short-term mortality benefits when selected according to patient characteristics.
Hepatitis C virus (HCV)-related nephropathy often progresses silently and is commonly underrecognized until chronic kidney disease or acute kidney injury occurs. Urinary alpha-1-microglobulin (Uα1M) is a promising early biomarker of proximal tubule dysfunction. It may help detect the subclinical renal extrahepatic manifestations of HCV earlier than traditional markers such as serum creatinine (SCr). The early renal manifestations of HCV include microalbuminuria, hematuria, tubular injury, and immune-mediated glomerulopathy. To evaluate the efficacy of Uα1M in identifying the early kidney involvement in patients with HCV infection. A case-control study was conducted from February 2022 to February 2024 at the Clinic of Nephrology Outpatient, Department of Internal Medicine, and Clinic of El-Rajhy Hepatitis Outpatient at Assiut University Hospitals. This study involved 158 patients aged ≥ 18 years, divided into HCV and control groups. The HCV group included 79 patients diagnosed as HCV-positive by HCV + antibodies and positive real-time polymerase chain reaction for HCV-RNA. The control group included 79 participants who were age-matched and sex-matched, and HCV-negative healthy individuals. The primary outcome was the rate of increased level of Uα1M. The two groups were comparable in age and sex distribution. The mean hemoglobin level and platelet count were significantly lower in HCV patients than in controls, respectively. Blood urea nitrogen (BUN), SCr, and estimated glomerular filtration rate (eGFR) showed no significant differences. The urinary albumin/creatinine ratio was significantly higher in HCV-positive patients, with increased prevalence of microalbuminuria and macroalbuminuria. Uα1M levels were markedly elevated in the HCV group. It correlated positively with BUN and SCr, and negatively with eGFR, aspartate aminotransferase, and alanine aminotransferase. Uα1M levels were significantly higher in patients with hematuria (P = 0.007) and those with impaired eGFR (P < 0.001) than those without these disorders. Only five HCV-positive patients underwent renal biopsy, and all showed membranoproliferative glomerulonephritis. The Uα1M levels higher than the 3.52 mg/L cutoff had strong diagnostic ability to distinguish HCV-positive from HCV-negative subjects, with an area under the curve of 0.864 (95% confidence interval: 0.801-0.913), 77.0% accuracy, 60.0% sensitivity, 93.7% specificity, 90.4% positive predictive value, and 69.8% negative predictive value (P < 0.001). Uα1M served as a valuable early renal tubular biomarker for detecting subclinical kidney involvement in chronic HCV patients. It showed a moderate correlation to BUN and mild correlation to SCr and eGFR, with membranoproliferative glomerulonephritis pathology predominance in biopsied cases. In addition, it had a strong diagnostic accuracy at levels higher than a cutoff of 3.52 mg/L, reinforcing its potential for early diagnosis of renal involvement by HCV infection.
Urinary tract infections (UTIs) are the most common postoperative complications of percutaneous nephrolithotomy (PNL). Besides the significant threat to the patient's life, they represent a surgical, financial, and stressful burden to the healthcare systems. Duration of the procedure, bacterial load in urine, severity of obstruction, and presence of infected stone directly increase the incidence of UTI. To identify the perioperative predictors of postoperative UTIs in patients undergoing PNL in Assiut University Urology Hospital, Assiut, Egypt. A prospective study was conducted at Assiut University Urology Hospital, Assiut University, Egypt, involving adult patients who underwent PNL from May 2022 to March 2023 for postoperative UTI. The sample size was calculated based on the previous studies and the PNL rate in our hospital, using Thompson's equation. Patients who had other surgical procedures besides PNL, had immunosuppression, congenital kidney malformations, or refused to participate were excluded. Patients were recruited consecutively during the study duration. The Excel sheet was used for data collection, and the Statistical Package for the Social Sciences (SPSS) program, version 26, was used for statistical analysis. The authors analyzed the preoperative, operative, and postoperative variables using both univariate and multivariate analyses. The statistical cutoff point for significance was set at P < 0.05. This study included 157 patients: 96 (61.1%) males and 61 (39.9%) females. The mean ± SD (range) age was 47.37 ± 12.47 (20-65) years. The mean body mass index ± SD (range) was 24.44 ± 2.84 (16.80-33.80) kg/m2. Thirty-one patients (19.7%) had postoperative UTIs. The univariate analysis revealed that the presence of a history of pyuria (P = 0.026), diabetes mellitus (P = 0.010), large stone size (P < 0.001), multiple renal punctures (P = 0.001), prolonged operative time (P = 0.004), placement of a double-J stent (P = 0.027) or nephrostomy tube (P = 0.021), higher blood transfusion rate (P = 0.024), residual stones (P = 0.002), and prolonged urethral catheterization (P = 0.001) were associated with the incidence of UTIs. The multivariate analysis demonstrated that the presence of diabetes mellitus [odds ratio (OR) = 0.15, confidence interval (CI): 1.1-4.41], stone size (OR = 2.15, CI: 0.14-1.13), and residual stone (OR = 0.16, CI: 0.03-0.93) were independent predictors for postoperative UTIs. Thirty-one out of 157 patients experienced UTIs following PNL. The presence of diabetes mellitus, larger stone size, and residual stones were identified as independent risk factors for postoperative UTIs after PNL. We suggest conducting further research to identify factors that may aid in the early detection of post-PNL UTI risks.
In this editorial, we comment on the article by Diniz et al published in the recent issue of the World Journal of Nephrology. Point-of-care ultrasound (POCUS) is rapidly becoming a transformative tool in nephrology and medicine in general, which can be used in both inpatient and outpatient settings. With approximately 850 million people living with chronic kidney disease worldwide, POCUS offers nephrologists a real-time, non-invasive method to avoid diagnostic delays and accelerate complex treatment pathways. Its clinical applications include the assessment of hemodynamics, volume status, vascular access guidance, and dialysis-related complications. By improving clinical decision-making at the bedside and thereby reducing unnecessary testing and healthcare inefficiencies, POCUS can transform and implement nephrology practice. The inclusion of a certifiable, standardized POCUS curriculum in undergraduate medical education is a worthy and feasible goal. Early exposure to ultrasound-based diagnostic tools would greatly enhance nephrology education and equip future physicians with important skills that could transform clinical practice.
In this editorial, we comment on the article by Song et al published in the recent issue of the World Journal of Nephrology, which investigates the mechanistic role of gut microbiota-derived trimethylamine N-oxide (TMAO) in accelerating diabetic kidney disease through renal fibrotic pathways. Diabetic kidney disease is increasingly recognised as a disorder influenced not only by intrinsic renal metabolic and inflammatory pathways. In the Zucker diabetic fatty model, the investigators demonstrate a reproducible pattern in which progression of renal injury is accompanied by distinct alterations in gut microbial composition and a marked rise in circulating TMAO concentrations. The incorporation of fecal microbiota transplantation further shows that the dysbiotic microbial environment characteristic of diabetic kidney disease possesses an intrinsically enhanced capacity to generate TMAO and can transfer this metabolic profile to recipient animals, establishing functional evidence that gut microbial changes can modify host metabolite production. Partial improvement in renal biochemical parameters, fibrotic protein expression, and histological abnormalities following inhibition of trimethylamine formation reinforces the mechanistic relevance of this pathway within the gut-kidney axis and supports the concept that therapeutic strategies targeting microbial metabolism may offer a promising direction for altering the clinical trajectory of diabetic kidney disease.
Contrast-associated acute kidney injury (CA-AKI) is a common and serious complication of percutaneous coronary intervention (PCI). It is linked to higher rates of morbidity and mortality. Early detection of patients at risk is crucial for implementing timely preventive actions. Osteopontin (OPN), a multifunctional glycoprotein highly expressed in kidney tissue, has been suggested as a potential biomarker for AKI. However, its role in CA-AKI remains unclear. To evaluate the predictive value of serum OPN levels for early identification of CA-AKI in patients undergoing PCI and to compare its diagnostic performance with the Mehran risk score and traditional clinical predictors. A prospective, non-randomized comparative study was conducted at Assiut University Hospitals between March 2023 and March 2024. A total of 155 patients who underwent elective or primary PCI were enrolled. Exclusion criteria included chronic kidney disease, prior CA-AKI, cardiogenic shock, obstructive uropathy, malignancy, or nephrotoxic drug use. Serum OPN was measured immediately before and after PCI by ELISA alongside routine renal function tests. CA-AKI was defined as ≥ 0.3 mg/dL absolute or ≥ 50% relative rise in serum creatinine within 7 days post-contrast. The primary outcomes were the rate of CA-AKI after PCI and changes in OPN levels. Patients with CA-AKI were compared with patients without CA-AKI. Logistic regression and receiver operating characteristic curve analyses were performed to assess predictors and diagnostic accuracy. CA-AKI occurred in 20 patients (12.9%). These patients were significantly older (59.54 ± 8.67 years) than those without CA-AKI (48.19 ± 7.89 years; P < 0.001). Patients with CA-AKI had significantly higher OPN levels before and after PCI compared with those without CA-AKI (P < 0.001). Independent predictors of CA-AKI included pre-PCI OPN [odds ratio (OR) = 3.22], post-PCI OPN (OR = 2.90), contrast volume (OR = 1.22), and Mehran score (OR = 3.10). Pre-PCI OPN > 69.6 ng/mL demonstrated 86.8% accuracy (area under the curve of 0.80). Combining OPN with the Mehran score produced a diagnostic accuracy of 88% (area under the curve of 0.95). Elevated OPN levels, both before and after PCI, independently predicted CA-AKI and enhanced the predictive power of the Mehran score. Routine assessment of OPN may provide an effective strategy for early risk stratification in patients undergoing PCI.
The prostatic urethral lift (PUL) for benign prostatic hyperplasia (BPH) has been shown to deliver rapid, durable symptom relief with low morbidity. Most studies have been performed in Western populations. The objective was to understand how PUL performs in the real world in Japan among a broad patient population. A post-market registry study of consecutive PUL subjects across 14 Japanese centers was conducted. International Prostate Symptom Score (IPSS), quality of life (QOL), maximum flow rate (Qmax) and sexual function were evaluated at baseline, 3- and 12- months post-procedure. Paired t-tests compared baseline and follow-up data. Subject demographics, adverse events, BPH medication use, catheterization, and surgical retreatment were reported. 210 subjects were included. Baseline characteristics included age 74.3 ± 8.5 years, IPSS 18.0 ± 7.4, QOL 4.8 ± 1.3, Qmax 10.3 ± 5.5 mL/s and prostate volume 40.5 ± 16.1 cc. Paired analyses indicated IPSS improved 6.6 (36.9%), p < 0.0001; QOL improved 2.1 (43.3%), p < 0.0001 and Qmax improved 1.5 (14.7%) mL/s (p = 0.023) at 12 months. Sexual function measures were unchanged or significantly improved, although results should be interpreted with caution due to a high degree of missing data. BPH medication use decreased from 76.7% to 12.4%; One subject was surgically retreated by 12 months. Adverse events were typically mild-moderate and transient. This registry study from Japan indicates PUL is safe and effective; results corroborate those of previous studies. The data support the use of PUL in the broader BPH population in Japan. Japan Registry of Clinical Trials (jRCT 2032220377).
Important determinants of dialysis adequacy are blood flow rate (BFR) and dialysis time. This study aimed to evaluate the impact of BFR and duration of dialysis session on nutritional status and quality of life (QoL) in hemodialysis (HD) patients. Real-world evidence studies (RWE) of 3 HD units that differ in BFR and/or dialysis time. Group I, HD 5 hours and BFR 200-250 mL/minute; group II, HD 4 hours and BFR 270-320 mL/minute, and group III, HD 4 hours and BFR 200-250 mL/minute. All HD units use the same dialysate flow and dialysis frequency. The 3-point Subjective Global Assessment (SGA) scale is used to assess nutritional status, while QOL is assessed using the SF-36. There were 291 chronic HD patients with an average age of 51 (12.3) years, 50.5% were male. The proportion of SGA classes between groups did not differ significantly. Group I was associated with significantly higher PF and RP domain scores of PC and VT domain scores of MC compared to Group III. On the other hand, Group II was associated with significantly lower VT and MH domain scores of MC compared to Group I, while the other domains were not significantly different. In general, Group III had the lowest SF-36 scores compared to the other 2 groups. Duration of HD was not associated with nutritional status. Compared with 4-hour HD but with a faster BFR, 5-hour HD was associated with higher Mental Component QOL scores, but not Physical Component scores.
Acute pancreatitis (AP) is clinically heterogeneous, and early identification of patients at risk for severe progression remains challenging. Glycated hemoglobin (HbA1c) reflects long-term glycemic exposure, but its prognostic relevance in AP is unclear. This study evaluated the association of admission HbA1c with AP severity and complications. We conducted a retrospective study of 324 patients hospitalized with AP at a single tertiary center. Patients were categorized into quartiles by admission HbA1c. Multivariable logistic regression assessed associations between HbA1c quartiles and severe AP or complications. Restricted cubic spline analyses explored nonlinear relationships and potential inflection points. Prespecified subgroup analyses tested robustness. Higher HbA1c levels were associated with less favorable metabolic profiles and stronger inflammatory responses at presentation. Excess risk was mainly concentrated in the highest HbA1c quartile, which showed the clearest association with severe AP and pancreatitis-related complications. Restricted cubic spline analysis demonstrated a significant nonlinear association between HbA1c and severe AP, with a potential inflection point around 6.25%, above which risk increased more markedly. A similar pattern was observed for pancreatitis-related complications. These associations were generally consistent across prespecified subgroups. However, exploratory models based on baseline admission variables, including HbA1c, showed limited discrimination, with an AUC of 0.573 for severe AP and 0.665 for complications. HbA1c may serve as an adjunct marker of metabolic vulnerability rather than a strong standalone predictor. The spline-derived inflection point should be considered exploratory and requires external validation.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a multisystem disorder strongly associated with metabolic dysfunction. Emerging evidence suggests a close association between MASLD and chronic kidney disease (CKD). However, the magnitude and determinants of renal involvement remain inconsistent across studies, particularly in relation to diabetes mellitus (DM) and hepatic fibrosis. To assess the association between CKD and MASLD and identify the predictors of renal impairment in patients with MASLD. A case-control study was conducted in the Internal Medicine Department, Faculty of Medicine, Assiut University, Egypt, between March 2024 and March 2025. It included 150 participants recruited from outpatient clinics. Participants were divided into three groups: Those with MASLD and type 2 DM (n = 50), those with MASLD without DM (n = 50), and healthy controls (n = 50). All participants underwent clinical and laboratory evaluation. Additionally, they were assessed for insulin resistance using Homeostasis Model Assessment of Insulin Resistance, abdominal ultrasound, and FibroScan. CKD was defined based on the estimated glomerular filtration rate and albuminuria. Multivariate logistic regression was used to assess the factors associated with CKD in patients with MASLD. The three groups were similar in terms of mean age (P = 0.102) and gender (P = 0.553) distribution of the participants. However, the incidence of hypertension and ischemic heart disease was significantly higher in patients with MASLD than in those without. Patients with MASLD exhibited significantly higher serum creatinine, urea, and albuminuria levels, along with lower estimated glomerular filtration rate (P < 0.001). Advanced hepatic fibrosis was more prevalent in MASLD with DM, with F3-F4 fibrosis observed in 50% of patients compared to 14% in those with MASLD without DM. The severity of fibrosis and steatosis increased progressively with advancing CKD stage (P < 0.001). Factors associated with CKD included hepatic fibrosis score [odds ratio (OR) = 5.61], steatosis score (OR = 4.17), Homeostasis Model Assessment of Insulin Resistance (OR = 4.15), DM (OR = 3.10), and obesity (OR = 2.37). MASLD is associated with CKD, particularly in patients with DM and advanced hepatic fibrosis. Incorporating non-invasive liver fibrosis assessment may aid in the early identification of patients with MASLD who are at a high risk of renal disease.
Point-of-care ultrasound (POCUS) is increasingly being used in prehospital emergency medicine. While physician-performed prehospital ultrasound is well established, evidence regarding the feasibility and diagnostic accuracy of paramedic-performed POCUS in real-world settings remains limited. We conducted a retrospective observational cohort study evaluating paramedic-performed POCUS following a structured, multimodal training program. Twenty-one certified paramedics performed handheld ultrasound examinations in prehospital emergencies using standardized protocols with an observation period of 24 months, starting from March 2023. Feasibility, utilization patterns, diagnostic accuracy, and perceived clinical impact were assessed using standardized documentation. Hospital diagnoses served as the reference standard, based on radiological, sonographic, and/or clinical documentation. A total of 169 ultrasound examinations were performed on 144 patients. The overall diagnostic performance achieved a sensitivity of 87.9% and specificity of 92.7%. Diagnostic accuracy, defined as the concordance between prehospital POCUS-based working diagnoses and final in-hospital diagnoses, was particularly strong for lung ultrasound (pneumothorax, pulmonary edema, pneumonia and pleural effusion; sensitivity 91.7%, specificity 100%) and eFAST (sensitivity 100%, specificity 96.5%), while for the abdominal ultrasound examinations, the specificity was 70% and sensitivity was 71.43%. Ultrasound findings influenced logistical and clinical decision-making in a substantial proportion of missions, including changes in transport urgency (36.1%) and hospital destination (18.1%), whereas emergency room prealerts were avoided in 9.7% of cases. Training resulted in significantly more positive attitudes regarding feasibility, clinical relevance, and image of paramedic-performed ultrasound. Concerns regarding time delay and workload were markedly reduced. Paramedic-performed prehospital POCUS is feasible after structured training and can be integrated into routine prehospital care. Prospective studies should further assess the diagnostic accuracy, reliability, and clinical impact of paramedic-performed POCUS in the prehospital setting.
Vaccination remains a cornerstone of public health, yet concerns regarding serious adverse events continue to contribute to vaccine hesitancy. While systemic and local vaccine reactions are well described, renal complications such as acute kidney injury (AKI) and immune-mediated glomerular disease are less well characterised. With widespread and sustained use of coronavirus disease 2019 (COVID-19) and influenza vaccines, a comprehensive synthesis of reported renal adverse outcomes is needed. To synthesise and critically evaluate the existing evidence on AKI and other renal manifestations reported following influenza and COVID-19 vaccination. Specifically, it aims to characterise the spectrum of reported renal presentations, summarise clinical features and timelines described in case reports and case series, and contextualise these findings using population-level observational and pharmacovigilance data to assess the overall renal safety profile of these vaccines. We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed and EMBASE were searched from inception to 6 December 2025 for studies reporting renal outcomes following COVID-19 or influenza vaccination. Eligible studies included observational studies, pharmacovigilance analyses, case reports, and case series. Data on incidence, clinical presentation, timing of onset, management, and outcomes were extracted and synthesised narratively due to heterogeneity. Risk of bias in observational studies was assessed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool. A total of 255 COVID-19 vaccine-related studies and 73 influenza vaccine-related studies met the inclusion criteria, supplemented by additional studies identified through reference screening. Population-level observational studies consistently demonstrated a low absolute risk of renal adverse outcomes following vaccination, with several studies reporting reduced AKI-related risk among vaccinated individuals. In contrast, pharmacovigilance analyses and case reports described serious instances of de novo or relapsing renal disease, including minimal change disease, immunoglobulin A nephropathy, membranous nephropathy, pauci-immune glomerulonephritis, and systemic inflammatory syndromes with secondary renal involvement. Symptom onset typically occurred within days to weeks of vaccination. Most cases responded favourably to supportive or disease-specific therapy, with recovery observed over weeks to months; irreversible renal outcomes were uncommon. Current evidence indicates that both COVID-19 and influenza vaccines are associated with a low population-level risk of adverse renal outcomes. Serious immune-mediated renal events have been reported in temporal association with vaccination, likely reflecting idiosyncratic immune responses or unmasking of pre-existing disease rather than a widespread nephrotoxic effect. The overall benefits of vaccination substantially outweigh potential renal risks. Ongoing surveillance and well-designed population-based studies remain essential to refine risk estimates and identify susceptible subgroups.
Psychological distress is highly prevalent among patients undergoing maintenance hemodialysis and may adversely affect treatment adherence and overall quality of life. Evidence-based nursing (EBN) practices and cognitive behavioral theory (CBT)-based approaches have each shown potential value in dialysis care. However, evidence regarding their integration into routine nursing practice in real-world clinical settings remains limited. This study aims to examine the impact of exposure to a structured nursing care pathway incorporating EBN and CBT-informed supportive nursing on psychological, quality-of-life, and selected clinical stability outcomes in patients receiving maintenance hemodialysis. This single-center retrospective cohort study included 236 adult patients with chronic renal failure undergoing maintenance hemodialysis between March 2023 and February 2024. Patients were classified according to the nursing care pathway received during routine clinical practice: standard care or a structured nursing care pathway integrating EBN and CBT-informed supportive communication. Propensity score matching (1:1) was applied to balance baseline demographic, clinical, laboratory, and psychological characteristics. Outcomes assessed over a 12-week observation period included nutritional markers (hemoglobin and serum albumin), the Kt/V, psychological status (Self-Rating Anxiety Scale and Self-Rating Depression Scale), quality of life (Generic Quality of Life Inventory-74), and dialysis-related complications. After propensity score matching, 186 patients (93 per group) were included in the final analysis. Renal function indicators, electrolyte levels, and inflammatory markers remained stable in both groups throughout follow-up, with no significant between-group differences. Anxiety and depression scores were lower at follow-up in the structured nursing care pathway group than in the standard nursing care group (both p < 0.001), and both groups showed reductions in these scores from baseline (both p < 0.001). At follow-up, the structured nursing care pathway group had higher quality-of-life scores in the physical, psychosocial, and social domains (all p < 0.05), whereas no significant between-group difference was observed in the material well-being domain (p > 0.05). Dialysis adequacy and nutritional indicators were maintained within clinically acceptable ranges in both groups. The incidence of dialysis-related complications was lower in the structured care group, although statistical significance was not observed. In a real-world clinical setting, exposure to a structured nursing care pathway incorporating EBN and CBT-informed supportive communication was associated with more favorable psychological outcomes and selected quality-of-life domains among patients undergoing maintenance hemodialysis, without compromising clinical stability. These findings suggest the potential value of optimizing nursing care pathways to address psychosocial needs in hemodialysis care.
Acute kidney injury (AKI) is a clinical syndrome that, even after recovery of normal renal function, increases the short-term risk of developing chronic kidney disease and may contribute to mortality in hospitalized patients. To assess patient survival and identify risk factors for mortality. We conducted a retrospective cohort study with longitudinal follow-up of patients hospitalized between January 2002 and December 2015, who had an episode of AKI as defined by the Kidney Disease Improving Global Outcomes 2012 guidelines, with return to normal renal function with follow-up extending up to 5 years after discharge, with a median follow-up of 7 years. Patient survival was verified using civil status records and by telephoning patients or their relatives. Risk factors were assessed using univariate and multivariate survival analyses. Short-term mortality was assessed between 3 months and 1 year, medium-term between 1 year and 5 years, and long-term beyond 5 years. A total of 214 patients were included, with mortality data available for 193. Of these, 18 patients (9.3%) died within the short term (mean: 9.22 ± 0.67 months), 18 patients (10.2%) died within the medium term (mean: 36.27 ± 2.73 months), and 26 patients (16.5%) died within the long term (mean: 103.6 ± 6.63 months). The overall mean survival was 159 months. The Kaplan-Meier survival curve showed overall survival rates of 79%, 68%, and 57% at 5 years, 10 years, and 14 years, respectively. Identified mortality risk factors included age over 65, hypertension, diabetes, vascular disease, high Charlson comorbidity index, potassium levels above 5.5 mmol/L, pre-renal AKI, and the short-term development of chronic kidney disease. These findings highlight the need to identify patients at higher risk of mortality following an AKI episode.
Tuberculosis preventive treatment (TPT) is essential for tuberculosis elimination; however, evidence on its safety and feasibility in medically complex, high-risk populations is limited. Concerns regarding adverse events frequently hinder treatment initiation and completion in routine clinical practice. The Safety of Preventive Treatment in People at Risk for Tuberculosis (STEP-TB) study aims to generate real-world evidence on the safety of TPT among individuals at high risk of developing active tuberculosis disease and to identify factors associated with adverse events, treatment initiation, adherence, and completion. STEP-TB is a multicenter, prospective observational cohort study conducted at four university-affiliated hospitals in the Republic of Korea. Adults aged ≥19 years who are eligible for latent tuberculosis infection (LTBI) testing or TPT according to national guidelines will be enrolled, including individuals with chronic kidney disease, chronic lung disease, diabetes mellitus, immunosuppressive conditions, malignancy, or occupational risk. LTBI testing will be performed using interferon-gamma release assays, and TPT regimens will follow national guidelines. Participants initiating TPT will be followed for up to 12 months from treatment initiation. Those with negative LTBI results or without TPT will be also followed for up to 12 months. Adverse events, treatment adherence, and completion will be systematically assessed. Blood samples, including volumetric absorptive microsampling, will be collected in a subset of participants for pharmacokinetic and pharmacogenetic analyses. The primary outcome is the occurrence of adverse events during TPT. Secondary outcomes include TPT completion rates, predictors of non-initiation and discontinuation, and progression to active TB. STEP-TB will provide condition-specific, real-world evidence on TPT safety and implementation, informing clinical decision-making, patient-centered care, and national TB control policies to support the safe expansion of LTBI treatment strategies in Korea. CRIS Registration Number: KCT0011063.
Chronic kidney disease (CKD), has emerged as a global public health challenge, with persistently high mortality rates among patients presenting to the emergency department, particularly in resource-limited low- and middle-income countries. I read with great interest the recent article published in the World Journal of Nephrology by Prabhahar et al, conducting a retrospective analysis from a large tertiary referral center in northern India and identifying three independent predictors of in-hospital mortality at emergency department admission: Decreased Glasgow coma scale score, hyperglycemia, and low serum albumin. The significance of this study lies in underscoring the prognostic value of dynamic physiological parameters, which appear to more accurately reflect acute illness severity than traditional measures such as CKD stage or long-term comorbidity indices. This editorial highlight three key implications for clinical practice: First, it is crucial for emergency and nephrology teams to recognize high-risk patients early; Second, implementing standardized risk stratification within the emergency guideline is essential; Third, future multicenter prospective studies could help validate these predictive markers across diverse populations. In conclusion, early identification and systematic risk assessment of high-risk CKD patients in the emergency department are important steps toward improving in-hospital outcomes.
This retrospective study analyzed 10,934 hyperkalemia episodes to compare outcomes between the hyperkalemia routine group and the hyperkalemia standardized group, the latter managed with a strategy supported by the 'Serum Potassium Management Center System' in a real-world implementation setting. The study compared process and outcome metrics between this system-level intervention cohort and the routine care cohort. The hyperkalemia standardized group exhibited significantly higher rates of diagnosis (19.00% vs. 15.43%), treatment (85.23% vs. 58.29%), and review (89.41% vs. 60.86%) (all p < 0.05). With respect to disease burden, the hyperkalemia standardized group was associated with lower hospitalization costs in the chronic kidney disease-heart failure (CKD-HF) and chronic kidney disease-diabtes mellitus-heart failure comorbid subgroups, as well as shorter hospital stays in the CKD-HF comorbid subgroup (all p < 0.05). A non-significant trend toward reduced hospitalization costs and shorter hospital stays was also observed in the CKD subgroup. In conclusion, implementation of the 'Serum Potassium Management Center System' was associated with improved quality of hyperkalemia care, as reflected by more favorable process indicators and disease burden-related outcomes. This trial was registered with the Chinese Clinical Trial Registry (ChiCTR) ChiCTR2600116550 on January 12, 2026.
Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259 000 (95% uncertainty interval 202 000-335 000) global deaths and 2·54 million (2·20-2·93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86 600 [53 300-149 000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98 700 deaths (77 000-127 000) and 594 000 cases (514 000-686 000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.