Fluid monitoring is critical for patients on maintenance hemodialysis. Bioimpedance enables estimation of fluid volumes from measures of electrical tissue properties. However, empirical equations are needed to approximate key variables, especially in wrist-to-ankle bioimpedance measurements, introducing potential errors.

Chronic kidney disease (CKD) is a public health and economic burden with serious adverse health outcomes and extremely low awareness. Current evidence on independent correlates of CKD awareness is inconsistent and recent data examining time trends of CKD awareness in the USA are dated. The aims of our study are to examine time trends in CKD awareness from 1999 to 2020 and examine independent correlates of CKD awareness in US adults with CKD.

Kidney dysfunction (KD) is a major metabolic risk factor for cardiovascular disease (CVD) and has been playing an increasingly significant role in the global burden of disease. However, there is still a lack of comprehensive, long-term, and systematic research assessing the global burden of CVD attributable to KD.

Introduction Intradialytic hypertension (IH) is associated with elevated ambulatory blood pressure (BP), volume overload, and endothelial dysfunction, which may contribute to its increased morbidity/mortality. There is a paucity of data on cardiac structural and functional abnormalities in IH patients. Methods In a cross-sectional analysis among 83 Veterans on maintenance hemodialysis with transthoracic echocardiograms (TTE), we analyzed all intradialytic BP measurements from 3 treatments before and 3 treatments after the TTE and defined IH as an intradialytic BP slope (IBPS)>0 mmHg/min averaged over these treatments. We compared systolic and diastolic dysfunction prevalence, ejection fraction (EF), left ventricular mass index (LVMI), left atrial volume index (LAVI), and early transmitral flow velocity to early diastolic mitral annular velocity ratio (E/e') and used logistic regression to determine if IH is independently associated with E/e'>14, a key criteria for diagnosing diastolic dysfunction and assessing elevated filling pressure. Results Mean age was 67.4 (±9.2) years. Most were men (n=81), and 71% had diabetes. IH was present in 25 patients (30%), and they had higher prevalence of systolic dysfunction (52% vs. 17%, p=.003) and Grade III diastolic dysfunction (16% vs. 2%, p=.03) reported on TTE compared to non-IH patients. IH patients had higher E/e' (18.5 [14-24] vs. 15.5 [11-19], p=.03), greater LVMI (137 [43] vs. 113 [38] mg/m2, p=.009), greater LAVI (52.7 [39-59] vs. 41.0 (33-48] mL/m2, p=.005) and lower EF (45.6% [17] vs. 55.7% [11], p=0.002). IH associated with E/e'>14 in multiple models controlling for demographics, EF, mean intradialytic BP or CV comorbidities (OR 3.59-3.85, p<.05 for all); but in the model with LVMI, the association was blunted (OR 2.86, p=.1). Conclusions: IH patients had a higher prevalence of TTE-reported systolic dysfunction and more severe diastolic dysfunction with more abnormalities than those without IH. IH independently associated with E/e'>14, even controlling for EF, intradialytic BP burden, and comorbid CV disease. Clinicians should consider TTE in IH patients to evaluate these abnormalities and optimize dialysis prescriptions and preventative pharmacologic therapies.

BK polyomavirus (BKPyV) in kidney transplant associated with adverse graft outcome. The aim of this study was to examine graft loss risk of BK polyomavirus associated nephropathy (BKPyVAN) and BKPyV-DNAemia in relation with de novo donor specific antibody and rejection status.

Urgent dialysis is labour-intensive and expensive because it requires specialized nursing staff. Most hospitals schedule a fixed number of nurses daily for urgent dialysis needs, but daily dialysis demand fluctuates, leading to inefficiencies.

Cardiovascular-kidney-metabolic (CKM) syndrome significantly impacts clinical outcomes, though evidence linking integrated cardiometabolic-kidney biomarkers to prognosis remains sparse. This study evaluated prognostic associations of these biomarkers and developed machine learning (ML)-based mortality prediction models for CKM patients.

Background Renin-angiotensin system inhibitors (RASi) are critical for cardiovascular diseases (CVD), but adverse effects sometimes lead to discontinuation, raising concerns about impacts on major outcomes. Although the observational studies have suggested continuation or re-starting of RASi, the evidence from randomized controlled trials (RCTs) and systematic reviews based on RCTs are not sufficient. Method We performed a systematic review and meta-analysis including only RCTs. We searched MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov, and EU Clinical Trials Register for the full text review analysis. Primary outcomes included all-cause death and CVD events. Risk of bias was assessed using version 2 of the Cochrane Risk of bias tool (RoB2), and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results Among the seven included RCTs (n=928), four studies (n = 745) reported all-cause mortality and two studies (n = 697) reported CVD events. The meta-analysis did not show difference in all-cause mortality (RR 0.95, 95% CI 0.54-1.65; I² = 0%) and cardiovascular events (RR 1.22, 95% CI 1.00-1.50; I² = 0%) between the intervention and control groups. The certainty of evidence was rated as very low for both outcomes because of risk of bias, imprecision, and clinical heterogeneity. Conclusion In this systematic review and meta-analysis, there might not be deference in the risk of all-cause mortality or CVD events following RASi discontinuation compared with continuation. The number of enrolled studies were limited, and the certainty of evidence was very low, thus our results should be interpreted carefully.

To explore the clinical value of diffusion-weighted imaging (DWI) combined with T2 mapping for the early evaluation of delayed graft function (DGF) after renal transplantation.

Endothelin-1 (ET-1) is a potent vasoconstrictor and is implicated in the pathogenesis of proteinuria and progressive chronic kidney disease (CKD). With the development of ET-1 receptor antagonists, there is interest in whether higher ET-1 concentrations are associated with a greater risk of adverse cardio-kidney events among high-risk patients, e.g., those with established CKD and type 2 diabetes mellitus (T2DM).

Previous studies found that frailty was an important risk factor for cardiovascular disease (CVD). However, the relationship between frailty and CVD risk across different cardiovascular-kidney-metabolic (CKM) syndrome stages remains poorly understood. This study investigated the association between frailty and incident CVD in populations with CKM syndrome stages 0-3.

Parathyroid hormone (PTH) induces browning of adipose tissue, leading to increased resting energy expenditure and loss of adipose and muscle tissues in animal models of kidney failure. However, its clinical significance in humans remains unclear. This study aimed to investigate whether PTH-lowering therapy with upacicalcet, a novel injectable calcimimetic, affects serum albumin levels as a surrogate marker of protein-energy wasting in patients on hemodialysis with secondary hyperparathyroidism (SHPT).

Cardiovascular-kidney-metabolic (CKM) syndrome represents an integrated pathophysiological framework encompassing cardiovascular disease, kidney dysfunction, and metabolic disorders. The difference between cystatin C-based and creatinine-based estimated glomerular filtration rate (eGFRdiff) may reflect pathophysiological processes beyond kidney function, yet its prognostic significance across CKM syndrome stages remains poorly understood.

Prognostic value of glomerular hematuria in primary membranous nephropathy (PMN) patients with nephrotic syndrome (NS) has not been well understood. We investigated the earlier improvement of hematuria in PMN patients with NS receiving immunosuppressive (IS) therapies to illuminate its prediction capacity for the treatment response and remission status at 12 months.

Methotrexate (MTX) is an antimetabolite anticancer agent that has been used at doses ranging from 20 mg/m2 of body surface area to 33,000 mg/m2. High-dose methotrexate (HDMTX), defined as doses higher than 500 mg/m2, is used to treat acute lymphoblastic leukemia, non-Hodgkin lymphoma, osteosarcoma, brain cancers, leptomeningeal spread of carcinomas, and other cancers. Depending on the dose and other factors, acute kidney injury occurs in 2%-39% of HDMTX courses and severe (Acute Kidney Injury Network grade 2 or higher) nephrotoxicity in approximately 2%, though incidence varies widely. Prompt recognition and treatment of delayed MTX elimination and renal dysfunction which includes increased hydration, high-dose leucovorin, and sometimes glucarpidase, is crucial to prevent life-threatening toxicities such as myelosuppression, mucositis, renal failure, and dermatitis.

Immune checkpoint inhibitors (ICIs) have improved cancer treatment; however, their use can be limited by immune-mediated adverse events, such as kidney damage. Diagnostic limitations of nephrotoxicity may lead to worsening of the patient's prognosis. This study aimed to validate a panel of urinary biomarkers as diagnostic tools for kidney damage in patients treated with ICIs.

Anemia is common in hemodialysis patients, and iron supplementation is essential for its management. However, the impact of baseline inflammation on the efficacy of oral versus intravenous iron remains unclear.

Albuminuria is an independent risk factor for renal interstitial fibrosis and induces G2/M phase arrest in proximal tubular epithelial cells. Although protein overload disrupts fatty acid metabolism, the mechanistic link to cell cycle arrest remains unclear. This study investigates the role of NIMA-related kinase 10 (NEK10), a serine/threonine kinase implicated in cell cycle regulation, in mediating albumin-induced lipid dysregulation and G2/M arrest, which exacerbate tubulointerstitial fibrosis.

Autosomal dominant polycystic kidney disease (ADPKD) has an elevated prevalence of intracranial aneurysms compared to the general population. However, the risk of de novo aneurysm formation in these patients remains unclear, leading to a lack of consensus regarding whom and when to follow. Although the data from the general population tend to be referred, this assumption needs caution because patients with ADPKD have different characteristics, such as location tendency, aneurysm size at rupture, and gene mutation. Here, we investigate the incidence of de novo aneurysm in ADPKD patients to examine whether patients without intracranial aneurysms on initial imaging need frequent follow-up.

Physical activity levels in hemodialysis patients are low and continue to decline, increasing mortality risk. Intradialytic exercise improves hemodialysis patients' quality of life and enhances their physical and psychological health. But existing reviews fail to provide the best evidence for enhancing physical activity levels in this population. This study is to examine the efficacy and safety of intradialytic exercise for hemodialysis patients.