BMC Nephrology

Xu, Yangjing; Chen, Yongtong; Mai, Xiaolu; Zhang, Min

doi: 10.1186/s12882-025-04363-1pmid: 40721748

BackgroundThe correlation between the neutrophil-to-lymphocyte ratio (NLR) and clinical outcomes in patients with chronic kidney disease (CKD) remains inconsistent.MethodsPubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant literature through March 8, 2025. All-cause mortality, major adverse cardiovascular events (MACE), cardiovascular death, and progression to end-stage renal disease (ESRD) or dialysis were evaluated. Odds ratios (OR) and 95% confidence intervals (CI) were used for effect estimation.ResultsThirty-six studies involving 26,074 patients were included. Meta-analysis indicated that high NLR was significantly associated with an increased risk of all-cause mortality (OR = 1.22, 95% CI: 1.15–1.29; p < 0.00001), MACE (OR = 1.42, 95% CI: 1.14–1.77; p = 0.002), cardiovascular mortality (OR = 1.21, 95% CI: 1.09–1.35; p = 0.0004), and ESRD (OR = 1.68, 95% CI: 1.17–2.43; p = 0.005). NLR levels were significantly higher in patients who died from all causes (SMD = 0.84, 95% CI: 0.58–1.11; p < 0.00001) and cardiovascular causes (SMD = 1.44, 95% CI: 0.77–2.11; p < 0.0001) compared to survivors. Sensitivity and subgroup analyses affirmed the robustness of the results. All indicators were rated as very low in the GRADE system.ConclusionNLR is significantly associated with all-cause mortality, MACE, cardiovascular mortality, and adverse renal outcomes in CKD. The results are relatively stable, but due to high heterogeneity and publication bias, its clinical application should be approached with caution. Given the study’s limitations, further large-scale prospective studies are required to confirm the association between NLR and CKD prognosis.Clinical trial numberNot applicable.

Shui, Kankan; Zhang, Hedong; Li, Tengfang; Hou, Jianfei; Lan, Gongbin; Peng, Fenghua; Yu, Shaojie; Xie, Xubiao; Dai, Helong; Peng, Longkai

doi: 10.1186/s12882-025-04307-9pmid: 40646454

BackgroundKidney transplantation is the optimal treatment for end-stage renal disease; however, the limited availability of donor kidneys hinders the advancement of this procedure. The utilisation of expanded criteria donor (ECD) kidneys and kidney donor profile index (KDPI) > 85% kidneys represents a significant initiative in addressing this shortage. Our study aimed to investigate the clinical outcomes of kidney transplantation by the ECD and KDPI > 85% kidneys, as well as the risk factors influencing graft survival, with the aim of providing a reference for the clinical application of the ECD and KDPI > 85% kidneys in Chinese population.MethodsThis retrospective analysis included 326 adult donor kidney transplant recipients from July 2018 to June 2020. The donor kidneys were classified into ECD kidneys (n = 110) and standard criteria donor (SCD) kidneys (n = 216) based on the United Network for Organ Sharing (UNOS) criteria, as well as into kidneys with KDPI > 85% (n = 42) and KDPI ≤ 85% (n = 284), according to the donor’s KDPI value. T tests, chi-square tests, and Mann-Whitney U tests were used to compare complications and renal function following kidney transplantation. Additionally, the log-rank test was used to assess differences in survival rates, whereas Cox regression analysis was conducted to identify risk factors associated with graft loss.ResultsAnalysis revealed that grafts from ECDs exhibited significantly poorer survival rates (P = 0.004), whereas the survival rates of their recipients were comparable (P = 0.710). No significant differences were observed between the ECD and SCD groups regarding the incidence of DGF (22.7% vs. 26.4%, respectively; P = 0.471) or AR (24.5% vs. 25.9%, respectively; P = 0.787). At 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years posttransplantation, the SCr level and eGFR in the ECD group were significantly lower than those in the SCD group (all P < 0.05); however, no differences were noted at 1 month posttransplantation. Furthermore, the SCr level and eGFR in the kidneys of patients with a KDPI > 85% were significantly worse than those in the kidneys of patients with a KDPI ≤ 85% at 6 months, 2 years, 3 years, and 4 years posttransplantation (all P < 0.05), with no differences being observed at 1 month, 3 months, and 1 year posttransplantation. Additionally, no significant differences were observed between the KDPI > 85% and KDPI ≤ 85% groups regarding the incidence of DGF, AR, graft survival, or recipient survival (all P > 0.05). Multivariate Cox regression analysis indicated that ECD kidneys (HR = 3.647, P = 0.003) and AR (HR = 4.675, P < 0.001) were independent risk factors for graft loss.ConclusionIn this validation study of the transplant scoring criteria based on the Chinese population, our study indicated that compared with SCD kidneys, ECD kidneys demonstrated poorer graft survival and a tendency towards inferior postoperative renal function. However, the rates of recipient survival, DGF, and AR were comparable. Additionally, graft and recipient survival, as well as the incidence of DGF and AR, in KDPI > 85% kidneys were also similar to those in KDPI ≤ 85% kidneys. Nevertheless, kidneys with a KDPI > 85% tended to exhibit inferior postoperative renal function. Thus, the KDPI score is a valuable tool for predicting graft function in Chinese population.

Petzke, Daniel; Hallinan, Christine Mary; Trevena, Judy; Manski-Nankervis, Jo-Anne

doi: 10.1186/s12882-025-04345-3pmid: 40691554

BackgroundCKD is a common but under-recognised condition that places significant burden on the individual and the health system globally. Our study applied a set of primary care quality indicators originally developed and validated using Canadian primary care data for screening, diagnosis and monitoring of CKD. These indicators were then applied to a large primary care dataset to assess CKD detection and management practices in Australia.MethodsWe used de-identified data from the Patron repository, which contains data extracted from electronic medical records (EMRs) in Australian general practices. The 16 CKD indicators developed using Canadian EMR data were applied to this dataset. These indicators measured and reported on the use of clinical and pathological tests to diagnose and monitor CKD, the prescribing of antihypertensive and statin medications, and on rates of influenza immunisation.ResultsAmong the 362,078 unique patients identified across 78 general practices, 24,348 had a diagnosis or pathology consistent with CKD, of whom only 28.1% (6,841) had a diagnosis of CKD recorded. Of the 26,307 patients who initially presented with an eGFR below 60 ml/min/1.73m2, 54.2% (14,254) underwent a repeat eGFR within six months and 28.8% (7,586) completed an ACR test. Of the patients recommended for screening based on the presence of risk factors, 76.1% had an eGFR performed within the last 18 months, whilst 34.2% had an ACR performed in the same period. Rates of monitoring of patients with CKD were slightly higher. A blood pressure had been recorded within the last 9 months in 71.1% of patients with CKD, and in 75.6% of the subset of patients with both diabetes and albuminuria. Around 45% of all patients with CKD were meeting their blood pressure targets at their last recording.ConclusionsThe results of this study demonstrate that it is feasible to derive meaningful and informative indicators of CKD diagnosis and management from primary care EMR data in Australia, which are comparable with international data. The low rates of CKD documentation and pathology monitoring provide opportunities for quality improvement initiatives to reduce disease burden.Clinical trial numberNot applicable.

Alshehri, Mohammed A.; Alkhlady, Husain Y.; Awan, Zuhier A.; Algethami, Mohammed Ridha; Al Mahdi, Hadiah B.; Daghistani, Hussam; Orayj, Khalid

doi: 10.1186/s12882-025-03954-2pmid: 39849386

BackgroundChronic kidney disease (CKD) is a prevalent global health issue affecting millions of patients worldwide, impacting quality of life, impeding physical and psychological well-being, causing financial stress, and increasing mortality rates. This study aimed to highlight the prevalence of CKD and its associated risk factors across Saudi Arabia. Method: This is a cross-sectional study conducted from 2015 to 2022, using data from 42 branches of a major network of diagnostic laboratories in Saudi Arabia, covering the country's 13 administrative areas.ResultsThe mean age was 40.35 ± 14.5 years. The highest proportion of participants resided in the Makkah region at 35.77%, followed by the Riyadh region at 25.75%. The overall prevalence of CKD was 4.76%, with most having CKD in stage 3 (3.5%). The prevalence of CKD was higher among males compared to females (5.83% vs. 3.88%) and increased significantly with age, being 0.45% among participants aged 18–29 years and reaching 50.94% among participants aged 90 years or older. Predictors of CKD included increasing age, male sex, administrative area (Makkah 1.40 [95% CI:1.26–1.55], Jazan 1.34 [95% CI:1.18–1.52], Najran 0.47 [95% CI, 0.39–0.57], Alqasim 0.73 [95% CI, 0.64–0.82]), and a high hemoglobin A1C. CKD in Saudi Arabia is influenced by various demographic and geographic determinants contributing to its prevalence and associated burden on the population.ConclusionThese findings emphasize the need for targeted screening and prevention strategies, especially for at-risk populations. Continued surveillance, early detection, and effective management are crucial to reducing CKD's burden and improving kidney health outcomes in Saudi Arabia. Further research is essential to better understand the disease's regional and demographic drivers.

Ge, W. W.; Zhang, H. L.; Liu, P.; Yin, L. X.

doi: 10.1186/s12882-025-04044-zpmid: 40045294

BackgroundMaintenance haemodialysis (MHD) has emerged as a primary treatment modality in individuals with end-stage kidney disease. However, haemodialysis not only affects physiological well-being but also significantly influences patients’ social engagement and quality of life. Consequently, investigating the present status and repercussions on social participation among individuals undergoing MHD has evolved as a crucial area of research. This study aimed to investigate the current status of social participation among patients undergoing MHD and analyse the influencing factors, providing a theoretical basis for clinical intervention.MethodsThis cross-sectional study utilised a convenience sampling method to select 441 patients undergoing maintenance haemodialysis (MHD) at seven tertiary hospitals in Lianyungang between January and May 2024 as survey participants. The study employed a general information questionnaire along with several assessment tools, including the Chinese version of the Impact on Participation and Autonomy; Social Support Rating Scale; Hospital Anxiety and Depression Scale; Pittsburgh Sleep Quality Index; Chinese version of the Functional Assessment of Chronic Illness Therapy-Fatigue; and Medical Outcomes Study Health Status Short Form. Patients with end-stage renal disease aged ≥ 18 years and undergoing MHD for ≥ 3 months were included. Those with other severe illnesses, psychiatric disorders, personality disorders, or inability to cooperate with the study were excluded. Multivariate linear regression analysis was used to identify factors influencing social participation in MHD patients.ResultsThe total score of social participation among patients on MHD was 54. Multiple linear regression analysis indicated that, based on the International Classification of Functioning, Disability, and Health framework, total scores of depression, total scores of social support, age, total scores of the fatigue scale, smoking history, and employment status were the main influencing factors of social participation in patients on MHD (P < 0.05).ConclusionsThe level of social participation among patients on MHD was moderate and in need of enhancement. Healthcare providers should prioritise older, unemployed patients and improve their social participation and quality of life by addressing issues such as fatigue, depression, and enhancing social support.

Zhang, Danfeng; Zhao, Tian; Gao, Liting; Zhu, Huan; Jin, Haowei; Liu, Guiling; Wang, Deguang

doi: 10.1186/s12882-025-04124-0pmid: 40316989

BackgroundThis study aimed to develop a nomogram to predict peritoneal dialysis (PD) adequacy in incident PD patients and identify those at high risk for low Kt/Vurea PD function.MethodsWe retrospectively analyzed 141 incident PD patients from January 2021 to January 2024. Baseline characteristics, including BMI, hemoglobin levels, and high transport PD membrane, were compared between patients with and without adequate PD function. Univariate logistic regression, LASSO analysis, and Random Forest (RF) algorithms were employed to identify potential biomarkers. Significant predictors were integrated into a multivariable logistic regression model to construct a predictive nomogram.ResultsThe study found that 32.1% of patients had low total Kt/Vurea. Significant predictors of low Kt/Vurea included smoking (OR 2.23, CI 1.47–5.85), BMI (OR 1.35, CI 1.17–1.59), hemoglobin levels (OR 0.98, CI 0.95–0.99), and High transport (OR 0.2., CI 0.04–0.72). These factors were incorporated into a nomogram, which demonstrated strong predictive accuracy, with a C-Index of 0.802 in the main study group. The model’s AUC was 0.778 (95% CI: 0.686–0.870), and Decision Curve Analysis (DCA) confirmed its clinical utility across a wide range of threshold probabilities.ConclusionsWe developed a nomogram that accurately predicts PD total Kt/Vurea in incident PD patients. This model can be a valuable tool for identifying patients at risk of low PD total Kt/Vurea, facilitating timely interventions to improve patient outcomes.

Hu, Xiaohua; Ye, Xianwu; Chen, Haimin; Wu, Bibo; Guo, Qi; Yu, Chen; Ding, Wei; Niu, Jianying; Zhao, Junli; Qi, Hualin; Zhang, Suhua; Xue, Cheng; Zhang, Liming

doi: 10.1186/s12882-025-03963-1pmid: 39849392

BackgroundOsteoporosis and sarcopenia frequently occur in patients with end-stage renal disease undergoing hemodialysis (HD), and depression is also a common mental health issue in this population. Despite the prevalence of these conditions, the interrelationships among them remain poorly understood in HD patients.MethodsIn this multicenter cross-sectional study, 858 HD patients from 7 dialysis centers were recruited. Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry. Skeletal muscle mass index (SMI) was calculated from body composition data obtained through multifrequency bioimpedance analysis (BIA), while handgrip strength (HGS) was measured with a dynamometer. Gait speed was evaluated with a 4-meter walk test, and depression was assessed using the Patient Health Questionnaire-9 (PHQ-9).ResultsAmong the 858 participants (524 men, 334 women), 39.2% had osteoporosis. The prevalence of sarcopenia and depression was 18.9% and 42.1%, respectively. Logistic regression analysis showed that SMI was significantly associated with a decreased risk of osteoporosis (OR = 0.638, 95% CI = 0.494–0.823, P = 0.001), while HGS was not(OR = 0.990, 95% CI = 0.963–1.017, P = 0.449). HD patients with sarcopenia were 1.92 times more likely to have osteoporosis than those without sarcopenia. Most notably, after adjusting for both sarcopenia and SMI, the risk of osteoporosis in HD patients with depression was 1.45 times higher than in those without depression (OR = 1.452, 95% CI = 1.060–1.989, P = 0.020).ConclusionsIn HD patients, increased muscle mass, rather than muscle strength, is linked to a lower risk of osteoporosis. Notably, depression emerges as a significant risk factor for osteoporosis in this population, highlighting the need for mental health considerations in managing bone health.

Ma, Fuhui; Wusiman, Reziwanguli; Ma, Rui; Wang, Xinling; Zhang, Kaidi; Guo, Yanying

doi: 10.1186/s12882-025-04075-6pmid: 40140779

We report a Gitelman syndrome (GS) pedigree from a Chinese family. The proband, a middle-aged man, presented with hypokalemia, hypomagnesemia, and unilateral limb paralysis. After a comprehensive evaluation, peripheral neuropathy and the cranial or spinal cord disorders were ruled out. Genetic testing identified a homozygous c.1964G > A variant in the SLC12A3 gene. Despite potassium and magnesium supplementation, the patient’s clinical symptoms persisted. Additionally, 13 heterozygous family members, including his parents, showed no typical GS manifestations. However, the proband’s two brothers, who also carried the same homozygous mutation and exhibited hypokalemia and hypomagnesemia, did not develop unilateral limb paralysis. This case suggests that the c.1964G > A variant may be associated with a severe GS phenotype, including unilateral limb paralysis. Clinicians should be aware of the diagnostic challenges and therapeutic limitations in managing GS, particularly in patients with severe manifestations. Genetic testing is essential for accurate diagnosis, and ongoing monitoring and symptomatic management are critical to improving the quality of life for affected individuals.

Liu, Caihong; Huang, Yongxiu; Wei, Wei; Hu, Xinyu; Yang, Jing; Zhao, Yuliang

doi: 10.1186/s12882-025-04082-7pmid: 40128702

Mercury intoxication is not uncommon and often presents with diverse symptoms of multiple systems. While neurological disorders and renal impairments have been examined in isolation, the concurrent occurrence of systemic symptoms linked to immune dysregulation is infrequently observed. Here, we report an unusual case that a 55-year-old male patient, who is a scrap merchant, was admitted to our center for neuropsychiatric disturbances, including incoherent speech and hallucinations. He was initially diagnosed with autoimmune encephalitis (AE) because of double positivity for CASPR2 and LGl1 antibodies in serum. The patient later presented with pruritus and nephrotic syndrome, where renal biopsy revealed membranous nephropathy (MN). In view of the mercury exposure history and elevated urinary mercury level, AE and MN were suspected to be related to mercury poisoning. The patient achieved a full recovery following a four-month treatment regimen comprising immunosuppressants and mercury-chelating agents, underscoring the significance of recognizing environmental toxins such as mercury in the coexisting diseases of different systems such as AE and MN.

Xu, Liang; Zhou, Zilin; Lv, Ying; Li, Ling; Yuan, Hai; Sun, Yaping; Hu, Fengqi

doi: 10.1186/s12882-025-04403-wpmid: 40830760

Multiple wasp stings that induce acute kidney injury (AKI) pose a significant threat to human health. This review focuses on the roles and mechanisms of inflammation in wasp sting-induced AKI. Relevant clinical studies, although limited in scope, have reported elevated levels of various inflammatory mediators in patients. These increased inflammatory mediators serve as indicators of inflammation and are potential predictors of wasp sting-induced AKI. However, clinical research is impeded by factors such as inconsistent patient baselines and lack of standardization for the use of wasp venom. To further explore the mechanisms, animal and cellular models have been developed to mimic the clinical manifestations. Basic studies have confirmed that inflammation plays a crucial role in such injuries. Importantly, mitochondrial DNA release and the cyclic GMP-AMP synthase-stimulator of interferon genes (STING) signaling axis have been identified as key regulators of the inflammatory response in wasp sting-induced AKI. These studies on inflammation present potential targets for therapeutic interventions, and plasma exchange has been proven effective. Overall, this review provides in-depth insights into the mechanisms and basis of therapeutic strategies for the treatment of wasp sting-induced AKI pathogenesis.