Role of macrophages in peritoneal dialysis-associated peritoneal fibrosis

Peritoneal dialysis (PD) can be used as renal replacement therapy when chronic kidney disease (CKD) progresses to end-stage renal disease. However, peritoneal fibrosis (PF) is a major cause of PD failure. Studies have demonstrated that PD fluid contains a significantly larger numbers of macrophages compared with the healthy individuals. During PD, macrophages can secrete cytokines to keep peritoneal tissue in sustained low-grade inflammation, and participate in the regulation of fibrosis-related signaling pathways, such as NF-κB, TGF-β/Smad, IL4/STAT6, and PI3K/AKT. A series of basic pathological changes occurs in peritoneal tissues, including epithelial mesenchymal transformation, overgeneration of neovasculature, and abnormal deposition of extracellular matrix. This review focuses on the role of macrophages in promoting PF during PD, summarizes the targets of macrophage-related inhibition of fibrosis, and provides new ideas for clinical research on delaying PF, maintaining the function and integrity of peritoneum, prolonging duration of PD as a renal replacement modality, and achieving longer survival in CKD patients.

The atherogenic index of plasma increases the risk of incident kidney stones: a nested case-control study in Chinese adults

OBJECTIVE

To investigate the association between atherogenic index of plasma (AIP) and risk of incident kidney stones.

METHODS

A nested case-control study was conducted using data from the Shanghai Kidney Stone Cohort from December 2018 to February 2023. Kidney stones were ascertained by ultrasound. Propensity score matching selected 2,550 patients with incident kidney stones and 5,100 controls from a total of 64,121 adults. Baseline fasting plasma samples were collected to measure the AIP, defined as the logarithm of the ratio triglycerides to high-density lipoprotein cholesterol. A multivariable conditional logistic regression model and restricted cubic spline were applied to examine the association between the AIP and the risk of incident kidney stones.

RESULTS

The baseline AIP values of the incident kidney stone patients and controls were 0.98 (0.67) and 0.91 (0.65), respectively. Patients with incident kidney stones had much higher baseline AIP levels than controls (p < 0.001). Participants in the highest AIP quartile had a 29% greater risk of developing kidney stones. Moreover, each increase in the standard deviation of the AIP was associated with a 10% greater risk of nephrolithiasis. A restricted cubic spline showed a significant positive and linear correlation between the AIP and the risk of developing kidney stones (P-overall = 0.040, P-nonlinear = 0.923). These findings remained robust in sensitivity analyses.

CONCLUSIONS

A higher AIP is associated with a greater risk of incident kidney stones.

The impact of tolvaptan on the incidence of contrast-induced acute kidney injury and long-term prognosis in high-risk patients after coronary intervention

OBJECTIVE

To investigate the effect of low-dose tolvaptan combined with hydration on the incidence of contrast-induced acute kidney injury (CI-AKI) and prognosis in high-risk patients undergoing coronary angiography or intervention.

METHODS

This single-center, randomized controlled clinical trial (ChiCTR2000028834) enrolled 232 patients scheduled for elective coronary angiography or intervention, randomly assigned to the experimental group (low-dose tolvaptan + standard intravenous hydration) or the control group (standard hydration alone). Multivariate logistic regression analysis was performed to explore factors associated with CI-AKI occurrence. Kaplan-Meier survival curve was plotted with major adverse cardiovascular events (MACEs) to compare six-month survival rates between the two groups.

RESULTS

The incidence of CI-AKI in the tolvaptan group was significantly lower than in the control group (10.3% vs. 23.3%, p = 0.008). Abdominal spectral CT at 24 h postoperatively showed that iodine concentration in the renal medulla was significantly lower in the tolvaptan group than in the control group (p < 0.05). The increases in creatinine and Cys-C levels and the decrease in eGFR were also significantly smaller in the tolvaptan group (p < 0.05). Multivariate logistic regression analysis indicated that tolvaptan use reduced the risk of CI-AKI (p = 0.001), while lower preoperative eGFR and higher AGEF scores were independent risk factors for CI-AKI (p < 0.05). Kaplan-Meier analysis showed no significant difference in MACEs incidence between groups over six months (93.9% vs. 88.6%, p = 0.142).

CONCLUSION

Low-dose tolvaptan combined with standard hydration reduces the incidence of CI-AKI in high-risk patients undergoing coronary intervention.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2000028834).

Research trends and performance of endothelin A receptor antagonist in kidney care: a bibliometric analysis

BACKGROUND

Endothelin A receptor antagonists (ERAs) have emerged as pivotal therapeutic agents in managing pulmonary hypertension (PH) and various kidney disorders, including chronic kidney disease (CKD) and proteinuric glomerular diseases such as IgA nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS). Although initially developed for pulmonary applications, recent research has highlighted their renoprotective effects, expanding their role in nephrology. This study presents a comprehensive bibliometric analysis of global research trends, key contributors, and emerging applications of ERAs in kidney care over the past three decades.

METHODS

A bibliometric analysis was performed using the Science Citation Index Expanded database (1992-2023). Relevant kidney-related publications were identified through specific keyword searches. Author performance was assessed using the Y-index.

RESULTS

ERA-related research has shown significant growth, particularly in nephrology. The United States and the University of Groningen lead in publication volume and international collaborations, with H.J.L. Heerspink emerging as a key contributor. While PH remains the dominant research focus, nephrology applications are rapidly increasing, particularly in CKD, diabetic nephropathy (DN), and glomerular diseases. A major milestone was the accelerated FDA approval of sparsentan for IgAN in 2023, followed by full approval in 2024 based on confirmatory efficacy data. However, challenges such as fluid retention and cardiovascular risks remain, necessitating further investigation into optimized ERA therapies, including combination strategies with SGLT2 inhibitors.

CONCLUSIONS

The expanding role of ERAs in nephrology underscores their potential in treating proteinuric kidney diseases. Ongoing international collaborations are advancing research on ERA safety, efficacy, and novel therapeutic strategies, supporting their broader clinical application.

The role of endothelin receptor antagonists in kidney disease

Kidney diseases are among the most prevalent conditions worldwide, impacting over 850 million individuals. They are categorized into acute kidney injury and chronic kidney disease. Current preclinical and clinical trials have demonstrated that endothelin (ET) is linked to the onset and progression of kidney disease. In kidney diseases, pathological conditions such as hyperglycemia, acidosis, insulin resistance, and elevated angiotensin II levels lead to an increase in ET. This elevation activates endothelin receptor type A, resulting in harmful effects like proteinuria and a reduced glomerular filtration rate (GFR). Therefore, to slow the progression of kidney disease, endothelin receptor antagonists (ERAs) have been proposed as promising new therapies. Numerous studies have demonstrated the efficacy of ERAs in significantly reducing proteinuria and improving GFR, thereby slowing the progression of kidney diseases. This review discusses the mechanisms of action of ERAs in treating kidney disease, their efficacy and safety in preclinical and clinical studies, and explores future prospects for ERAs.

Persistent lipoprotein(a) exposure and its association with clinical outcomes after acute myocardial infarction: a longitudinal cohort study

AIMS

To assess the link between persistent lipoprotein(a) [Lp(a)] exposure levels and clinical outcomes in patients with acute myocardial infarction (AMI).

METHODS

This longitudinal cohort study included 1131 AMI patients, categorizing persistent Lp(a) exposure based on measurements at admission and after 1 year. Patients were segmented into four groups using a 300 mg/L Lp(a) threshold: (1) persistent low Lp(a) (lowon admission - lowat 1 year); (2) fortified Lp(a) (lowon admission - highat 1 year); (3) attenuated Lp(a) (highon admission - lowat 1 year); and (4) persistent high Lp(a) (highon admission - highat 1 year). Multivariate Cox regression, subgroup analysis and sensitivity analysis assessed the association between Lp(a) trajectories and major adverse cardiovascular and cerebrovascular events (MACCE), cardiovascular death, non-fatal MI, non-fatal stroke, unplanned revascularization, and all-cause death.

RESULTS

Over a median 50-month follow-up, 343 (35.70%) patients encountered MACCE, and 210 (18.70%) died, including 126 (11.20%) from cardiovascular causes. The group with persistent high Lp(a) faced increased risk of MACCE (HRadjusted, 1.871; 95% CI: 1.474-2.374), non-fatal stroke (HRadjusted, 1.647; 95% CI: 1.031-2.632), unplanned revascularization (HRadjusted, 1.571; 95% CI: 1.008-2.449), and both all-cause (HRadjusted, 1.546; 95% CI: 1.134-2.108) and cardiovascular death (HRadjusted, 2.163; 95% CI: 1.405-3.331), compared to the persistent low Lp(a) group.

CONCLUSIONS

In AMI patients, sustained high Lp(a) levels were significantly associated with increased risk of MACCE, non-fatal stroke, unplanned revascularization, and both all-cause and cardiovascular death.

Role of microvascular pericyte dysfunction in antibody-mediated rejection following kidney transplantation

OBJECTIVE

To investigate the role of microvascular pericyte dysfunction in antibody-mediated rejection (ABMR) of transplanted kidneys.

METHODS

A total of 160 patients who underwent kidney transplantation in our hospital from 2004 to 2020 were enrolled, divided into 4 groups: ABMR group (n = 79), TCMR group (n = 20), mixed rejection group (n = 25) and control group (n = 36). Postoperative renal function indicators were compared, and immunohistochemical and immunofluorescence staining was performed on graft tissues and mice models using the pericyte marker PDGFR-β. An in vitro pericyte dysfunction model was co-cultured with vascular endothelial cells for functional assessment through Western blotting, PCR, and wound healing tests. KEGG pathway analysis from the GEO database identified gene expression changes in pericytes, which were further analyzed using electron microscopy and Western blot techniques.

RESULTS

There were statistically significant differences in creatinine, urea nitrogen, urine protein, and eGFR among the groups over time, with ABMR displaying the poorest outcomes. Immunohistochemistry revealed lower pericyte expression in ABMR, which was confirmed in mouse model studies showing reduced PDGFR-β expression in ABMR. KEGG analysis highlighted decreased autophagy in pericyte dysfunction, supported by electron microscopy and Western blot findings indicating reduced autophagy and pericyte damage, which could be reversed by chloroquine.

CONCLUSION

ABMR episodes worsened the long-term prognosis of transplanted kidneys. pericyte dysfunction appears to be one of the crucial causes of poor prognosis in ABMR patients. In vitro studies demonstrated that dysfunction of microvascular pericytes can result in damage to vascular endothelial cells, with autophagy impairment being a significant mechanism contributing to pericyte dysfunction.

Using network pharmacology and molecular docking technology, proteomics and experiments were used to verify the effect of Yigu decoction (YGD) on the expression of key genes in osteoporotic mice

BACKGROUND

Yigu decoction (YGD) is a traditional Chinese medicine prescription for the treatment of osteoporosis, although many clinical studies have confirmed its anti-OP effect, but the specific mechanism is still not completely clear.

METHODS

In this study, through the methods of network pharmacology and molecular docking, the material basis and action target of YGD in preventing and treating OP were analyzed, and the potential target and mechanism of YGD in preventing and treating OP were clarified by TMT quantitative protein and experiment.

RESULTS

Network pharmacology and molecular docking revealed that the active components of YGD were mainly stigmasterol and flavonoids. Molecular docking mainly studied the strong binding ability of stigmasterol to the target. Animal proteomics verified the related mechanism of YGD in preventing and treating OP. Based on the KEGG enrichment of network pharmacology and histology, our animal experiments in vivo verified that YGD may play a role in the treatment of OP by mediating hif1- α/vegf/glut1 signal pathway.

CONCLUSIONS

YGD prevention and treatment of OP may be achieved by interfering with multiple targets. This study confirmed that it may promote osteoblast proliferation and protect osteoblast function by up-regulating the expression of proteins related to HIF signal pathway.

Brachial plexus block versus local anesthesia for percutaneous transluminal angioplasty of dysfunctional arteriovenous fistula: 12-month results of a propensity score weighted study

OBJECTIVE

The study aimed to compare ultrasound-guided brachial plexus block (BPB) with local anesthesia (LA) on efficacy, safety and 12-month patency rate for percutaneous transluminal angioplasty (PTA) treatment of dysfunctional arteriovenous fistula (AVF).

METHODS

Consecutive patients with dysfunctional AVF who underwent PTA from January 2021 to December 2022 were included. Overlap weighting was performed to adjust for significant differences between the two groups. The primary efficacy outcomes included visual analogue scale (VAS) score and 12-month target-lesion primary patency rate. The secondary efficacy outcomes included target-lesion primary-assisted patency rate, secondary patency rate, access-circuit thrombosis rate, access-circuit reintervention rate, and number of reinterventions within 12 months. Univariate analysis and multivariate analysis by log-binomial regression were used to identify the independent factors associated with intraoperative pain.

RESULTS

218 patients were included in the study: 82 patients underwent PTA under BPB and 136 patients underwent PTA under LA. After overlap weighting, the baseline, lesion characteristics and intraoperative details had no significant difference between the two groups. Patients under BPB had significantly lower VAS scores than those under LA (2.4 ± 1.4 vs 5.1 ± 1.9, p < 0.001). The 12-month target-lesion primary patency rate was significantly higher in the BPB group than that in the LA group (58.3% vs 40.0%, p = 0.037). The 12-month target-lesion primary-assisted patency rate and access-circuit secondary patency rate were significantly higher in the BPB group than those in the LA group (p = 0.023 and p = 0.028). The access-circuit thrombosis rate was significantly lower in the BPB group (10.0%) than that in the LA group (28.3%) (p = 0.011). BPB was the only independent factor associated with mild pain (p < 0.001, OR: 0.037, 95%CI: 0.011-0.119).

CONCLUSIONS

BPB could decrease the intraoperative pain and improve the 12-month primary patency rates compared with LA for patients underwent PTA treatment of dysfunctional AVF.

Real-world assessment of sparsentan's drug safety framework

BACKGROUND

Sparsentan has been approved for reducing proteinuria in adult patients with primary IgA nephropathy (IgAN) at risk of rapid disease progression, yet comprehensive studies evaluating its drug safety framework are lacking.

METHODS

Adverse event (AE) reports following the market release of sparsentan were collected from the U.S. Food and Drug Administration AE Reporting System. Disproportionate analysis was used to identify previously unrecognized positive novel signals at both the system organ class and preferred term levels. Additionally, analysis on clinical priorities and subgroup analysis were conducted.

RESULTS

A total of 504 patients with IgAN were included. Two novel system organ classes and 14 novel preferred terms were identified. Hypotension and dizziness were established as moderate clinical priority events. Males had a higher relative risk of nausea, peripheral edema, feeling abnormal, decreased blood pressure, and hypotension, while females were at greater risk for fatigue, pain, increased blood creatinine, dizziness, and somnolence. Among those aged 18-45, the relative risk of experiencing fatigue, pain, and dizziness was higher, individuals aged 45 and older had a higher relative risk of peripheral edema, decreased blood pressure, and hypotension.

CONCLUSIONS

Based on the available AE reporting data, sparsentan exhibits a favorable safety profile, with no high-priority clinical events identified. Our findings offer valuable insights to optimize the use of sparsentan and understand its potential side effects.

Elevated concentrations of cardiac troponin T are associated with thoracic aortic calcification in non-dialysis chronic kidney disease patients of stage G3 to G5

BACKGROUND

Vascular calcification (VC), especially coronary artery calcification (CAC), serves as a robust predictor of cardiovascular mortality in chronic kidney disease (CKD) patients. Recent studies have revealed that the presence of extra-coronary calcifications (ECCs) contributes to cardiovascular disease (CVD). Elevated myocardial injury markers predict mortality risk in CKD patients and are associated with CVD. Nevertheless, the relationship between VC, including CAC and ECCs, and myocardial injury markers remain unexplored in non-dialysis CKD patients.

METHODS

In 278 non-dialysis CKD patients of stage G3 to G5, we assessed calcified scores in CAC (Agatston score) and ECCs including thoracic aortic calcification (TAC), abdominal aortic calcification (AAC), carotid artery calcification, and valvular calcification. We analyzed the relationships between VC and myocardial injury markers of cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB).

RESULTS

A total of 278 non-dialysis CKD patients (median age 52.4 ± 13.2; male 65.1%; diabetes 33.5%) were enrolled. A total of 71.8% (227) of patients had cTnT levels above the upper limit of normal (> 0.014 ng/mL). Moderate to severe (calcified score ≥100 vs. <100), CAC (OR 6.39; 95% CI 1.03-39.61) and TAC (OR 6.16; 95% CI 1.76-21.55) were significantly associated with higher cTnT concentrations after adjustment for confounders. Additionally, male sex and a lower eGFR were also associated with cTnT elevation. However, when we included CAC and TAC in one model, only moderate to severe TAC (OR 4.85; 95% CI 1.38-16.96) was a risk factor for cTnT elevation, but not CAC. Furthermore, patients with severer TAC presented lower diastolic blood pressure (DBP), wider pulse pressure (p < 0.001) and higher prevalence of left ventricular hypertrophy (LVH).

CONCLUSION

Moderate to severe thoracic aortic calcification (TAC score ≥ 100) is significantly associated with elevated cTnT concentrations in non-dialysis CKD patients of stage G3 to G5. The linkage may result from decreased coronary perfusion and relative myocardial ischemia.

Therapeutic potential of urinary extracellular vesicles in delivering functional proteins and modulating gene expression for genetic kidney disease

Chronic kidney disease (CKD) is a widespread health concern, impacting approximately 600 million individuals worldwide and marked by a progressive decline in kidney function. A common form of CKD is autosomal dominant polycystic kidney disease (ADPKD), which is the most inherited genetic kidney disease and affects greater than 12.5 million individuals globally. Given that there are over 400 pathogenic PKD1/PKD2 mutations in patients with ADPKD, relying solely on small molecule drugs targeting a single signaling pathway has not been effective in treating ADPKD. Urinary extracellular vesicles (uEVs) are naturally released by cells from the kidneys and the urinary tract, and uEVs isolated from non-disease sources have been reported to carry functional polycystin-1 (PC1) and polycystin-2 (PC2), the respective products of PKD1 and PKD2 genes that are mutated in ADPKD. uEVs from non-disease sources, as a result, have the potential to provide a direct solution to the root of the disease by delivering functional proteins that are mutated in ADPKD. To test our hypothesis, we first isolated uEVs from healthy mice urine and conducted a comprehensive characterization of uEVs. Then, PC1 levels and EV markers CD63 and TSG101 of uEVs were confirmed via ELISA and Western blot. Following characterization of uEVs, the in vitro cellular uptake, inhibition of cyst growth, and gene rescue ability of uEVs were demonstrated in kidney cells. Next, upon administration of uEVs in vivo, uEVs showed bioavailability and accumulation in the kidneys. Lastly, uEV treatment in ADPKD mice (Pkd1fl/fl;Pax8-rtTA;Tet-O-Cre) showed smaller kidney size, lower cyst index, and enhanced PC1 levels without affecting safety despite repeated treatment. In summary, we demonstrate the potential of uEVs as natural nanoparticles to deliver protein and gene therapies for the treatment of chronic and genetic kidney diseases such as ADPKD.

Fused exosomal targeted therapy in periprosthetic osteolysis through regulation of bone metabolic homeostasis

The onset of periprosthetic osteolysis is mediated by wear particles following artificial arthroplasty. This manifests as a disturbed bone metabolism microenvironment, characterized by insufficient osteogenesis and angiogenesis, and enhanced osteoclastic activity. To target and remodel the homeostatic environment of bone metabolism in the sterile region around the prosthesis, we successfully pioneered the proposal and construction of a fused exosome (f-exo) system with M2 macrophage-derived exosomes (M2-exo) and urine-derived stem cell exosomes (USC-exo). The results demonstrate that f-exo effectively combines the osteolysis region-targeting capabilities of M2-exo with the bone metabolic homeostasis modulation effects of two exosomes (M2-exo and USC-exo), thereby achieving a significantly enhanced bone metabolic homeostasis targeting effect in the periprosthetic osteolysis region. The proteomic analysis of M2-exo, USC-exo, and f-exo revealed the potential mechanism of f-exo in targeting-regulation of bone metabolic homeostasis. Our study employs an innovative approach utilizing the fused exosome system for exosome targeted delivery, which offers a novel intervention strategy for the clinical management of periprosthetic osteolysis. Furthermore, it provides a novel conceptual framework for the development of exosome-based drug-targeting delivery systems.

Label-free urinary protein detection through machine learning analysis of single droplet evaporation patterns

BACKGROUND

Chronic kidney disease (CKD) is a major global public health issue, with a steadily increasing incidence. Urinary protein detection serves as a crucial indicator for the diagnosis, monitoring and management of CKD. However, current methods for urinary protein measurement, such as urine dipstick tests, colorimetric assays, and 24-h total urine protein analysis, have certain limitations that restrict their routine application in CKD screening and follow-up. Therefore, there is an urgent need for a simple, convenient, and rapid diagnostic approach for kidney function assessment.

RESULTS

In this study, we have developed and validated a novel method for urine protein quantification based on dried droplet morphology analysis. Our approach demonstrates robust performance across a wide range of protein concentrations and is resilient to common interfering substances and variations in sample processing. It's worth noting that while our method shows excellent agreement with the colorimetric assay, it offers several potential advantages. These include reduced sample volume requirements, simplified sample preparation, and rapid analysis time. These factors could make our method particularly suitable for point-of-care testing or resource-limited settings where traditional laboratory infrastructure may be unavailable.

SIGNIFICANCE

The novel method for protein quantification in urine based on the morphology of a dried droplet uses only one drop of urine specimen. Combined with machine learning models, by identifying protein content in urine droplet drying patterns without the need for staining or antibody binding, may provide a more convenient alternative to current techniques for the assessment of proteinuria. Simple, low-cost, and fast, the system can be used as a powerful tool for CKD surveillance at the point of care.

Fibroblast growth factor 18 attenuates renal fibrosis via AMPK/NOX4 pathway in mice

Renal fibrosis, particularly tubulointerstitial fibrosis, is a prevalent pathological process contributing to the progression of chronic kidney disease (CKD). A growing body of evidence indicates that fibroblast growth factors (FGFs) play critical roles in kidney pathophysiology. However, the role of FGF18 in the pathogenesis of kidney fibrosis and the underlying mechanisms remain unclear. In this study, we discovered a significant upregulation of FGF18 in a folic acid (FA)-induced renal fibrosis model, as well as in transforming growth factor β (TGF-β) stimulated human proximal tubular cells (HK-2 cells). Furthermore, overexpression of FGF18 in the kidney significantly alleviated FA-induced fibrosis and diminished oxidative stress. Mechanistically, FGF18 upregulated AMP-activated protein kinase (AMPK) phosphorylation via its receptor FGFR3, leading to decreased NOX4-ROS levels, reduced oxidative stress, and ultimately inhibited the expression of fibrosis-related proteins. In conclusion, our findings suggest that FGF18 attenuates FA-induced renal fibrosis, at least in partly via AMPK/NOX4 pathway.

Enhancing RBP4 protein detection in clinical urine samples with solid-state nanopores through optimized sandwich immunoassay techniques

Nanopore technology is a promising single-molecule sensing platform that can identify substances through the precise monitoring of changes in ion currents. However, protein detection in clinical samples using solid-state nanopores remains challenging due to their heterogeneously charged spherical structure, which results in signals with extremely low signal-to-noise ratios (SNR) and low capture rates that are difficult to analyze. In this study, we employed a double-antibody sandwich technique to specifically capture and amplify the target antigen, which significantly improves the SNR and effectively distinguishes the target signal from background interference. Key factors including buffer composition, voltage, antibody concentration, and pore dimensions were systematically optimized to further improve capture efficiency. The optimized approach enabled precise and reliable detection of retinol-binding protein 4 (RBP4) with an excellent linear response within the range of 55 fM to 5.5 pM. Moreover, our method facilitates quantitative detection of RBP4 in clinical urine samples within 40 min, and achieves 100% accuracy in distinguishing between 11 urine samples from chronic kidney disease (CKD) patients and healthy donors, highlighting its robustness and specificity. Our research not only paves a new pathway for efficient RBP4 detection, but also provides valuable insights into the application of nanopore technology for the clinical diagnosis of protein biomarkers.

The impact of high intrapatient variability of tacrolimus in peripheral blood mononuclear cells on the outcomes of kidney transplantation

BACKGROUND

Tacrolimus (TAC) is a key immunosuppressive agent for kidney transplantation, but its narrow therapeutic window and high intra-patient variability (IPV) complicate therapeutic drug monitoring. The clinical significance of PBMC-based IPV in predicting graft rejection and infection remains unclear.

METHODS

A total of 47 renal transplant recipients were enrolled. Intracellular TAC concentrations were analyzed and quantified using liquid chromatography-tandem mass spectrometry. The primary endpoint was the occurrence of the first adverse event, including acute rejection or infection of any etiology. The IPV of peripheral blood mononuclear cells (IPVPBMC) and whole blood (IPVWB) was calculated as the coefficient of variation of dose-corrected concentrations from day 14 to month 12 post-transplantation. A Cox proportional hazards model was employed to identify risk factors associated with kidney transplant outcomes.

RESULTS

Within the first year post-transplantation, the incidence of acute rejection was significantly higher in the High-IPVWB group compared to the Low-IPVWB group (P = 0.024). Moreover, the IPVWB in the rejection group was significantly higher than in the stable group (P = 0.034), and High-IPVWB and extended post-operative hospital stay served as independent predictors of rejection within the first year. Additionally, High-IPVPBMC, deceased donors, and longer hospital stay were the main risk factors for early infection following transplantation.

CONCLUSIONS

Both IPVPBMC and IPVWB are significantly associated with graft rejection and infection. Monitoring IPVPBMC and IPVWB within the first six months post-transplantation could help identify high-risk patients and improve clinical management strategies.

Cardiovascular disease risk assessment, exercise training, and management of complications in patients with chronic kidney disease

Patients with chronic kidney disease are at high and very high risk of cardiovascular disease. As estimated glomerular filtration rate declines, the incidence and severity of risk factors, complications, and atherosclerotic cardiovascular events increase. In this scenario, tailored assessment is the key to evaluate the severity of chronic kidney disease and estimate cardiovascular disease risk. Personalized stratification differentiates patients with chronic kidney disease without diabetes mellitus or established atherosclerotic cardiovascular disease in their management and beneficial treatment. Exercise intensity assessment and prescription is suggested to propose specific and safe recommendations for physical activity, training, and cardiac rehabilitation. Programs are based on a combination of endurance and resistance exercise and should be adapted to very high risk chronic kidney disease and haemodialysis patients and after kidney transplantation. Appropriate management of cardiovascular complications in these patients, such as risk factors, heart failure, arrhythmias, and coronary artery disease, is essential to ensure the best treatment and improve the prognosis. Therefore, we propose a critical and comprehensive review to suggest how to manage patients with chronic kidney disease in clinical practice and, specifically, with regard to cardiovascular risk assessment, exercise training prescription, and management of complications.

Serum uric acid level as a prognostic biomarker in critically ill patients with sepsis-associated acute kidney injury: A retrospective single-center study

BACKGROUND

The predictive value of serum uric acid (SUA) for clinical outcomes in patients with sepsis-associated acute kidney injury (SA-AKI) remained unclear. Therefore, this study aimed to evaluate the clinical significance of SUA in predicting all-cause mortality among critically ill patients diagnosed with SA-AKI.

METHODS

This retrospective study examined 483 patients with SA-AKI at the Affiliated Hospital of Jiangsu University from January 2015 to July 2023. The primary outcome evaluated in this study was in hospital all-cause mortality. To assess the prognostic value of SUA, we employed receiver operating characteristic curves, restricted cubic splines, Cox regression models, and Kaplan-Meier survival analysis.

RESULTS

The hospital mortality and intensive care unit (ICU) mortality reached 43.3% and 42.2%, respectively. Kaplan-Meier analysis showed that the risk of 30-day mortality (log-rank test, P < 0.001) and 60-day mortality (log-rank test, P = 0.001) was significantly higher in patients with hyperuricemia (HUA). Multivariate Cox proportional hazards analysis showed that elevated SUA levels were significantly related to all-cause mortality. After accounting for potential confounding factors, patients with HUA maintained a significant correlation with both hospital mortality [HR (95%CI): 1.462 (1.094-1.952); P = 0.010] and ICU mortality [HR (95%CI): 1.474 (1.096-1.983); P = 0.010]. Further examination using restricted cubic splines revealed a progressively increasing risk of all-cause mortality with rising SUA levels.

CONCLUSIONS

Higher levels of SUA were associated with an increased risk of both hospital mortality and ICU mortality in critically ill patients with SA-AKI. These findings suggested that SUA may serve as an independent prognostic marker for these patients.

Elevated Remnant Cholesterol Improves the Prognosis of Patients With Ischemic Stroke and Malnutrition: A Cohort-Based Study

BACKGROUND

The mechanism of the lipid paradox remains uncertain, and malnutrition may be 1 explanation. In this prospective cohort study, we explored the associations between baseline remnant cholesterol (RC) concentrations and clinical outcomes in patients with ischemic stroke, stratified by nutritional status.

METHODS

Patients with ischemic stroke in a single-center prospective cohort (Shanghai, China) from January 2018 to December 2022 were studied. Individuals were classified into 3 groups based on their Controlling Nutritional Status score. Poor outcome and all-cause mortality during up to 3 months of follow-up were compared among patients with varied nutritional status and RC levels utilizing multivariate logistic regression analyses, RC splines, and subgroup analyses.

RESULTS

A total of 6892 patients with ischemic stroke were enrolled in the cohort, of which 5257 patients were included in the present study (without malnutrition: 2418 [46.0%]; mild malnutrition: 2516 [47.9%]; moderate-severe malnutrition: 323 [6.1%]). The median age was 69±12 years, and 3398 (64.6%) were male. Patients with moderate-severe malnutrition had the highest risks of poor outcome (198 [61.3%]; P<0.001) and all-cause mortality (106 [32.8%]; P<0.001) during the 3-month follow-up. A higher baseline RC level was an independent protective factor for adverse outcomes in patients with any degree of malnutrition (P<0.05), which was not observed in patients without malnutrition. In addition, compared with the moderate-severely malnourished with RC <0.471 mmol/L, the adjusted odds ratios for poor outcome and all-cause mortality were 0.805 (95% CI, 0.450-1.438) and 0.898 (0.502-1.607) for participants with 0.471 to 0.632 mmol/L, 0.259 (0.095-0.704) and 0.222 (0.061-0.810) for 0.633 to 0.868 mmol/L, and 0.160 (0.037-0.689) and 0.202 (0.042-0.967) for ≥0.869 mmol/L, respectively.

CONCLUSIONS

The lipid paradox was only observed in the malnourished patients with ischemic stroke. Strict lipid reduction therapy is still recommended for patients without malnutrition. However, when treating patients at any risk of malnutrition, the improvement of nutritional status may be more crucial.

Endothelin receptor antagonists for diabetic kidney disease: back to the future?

INTRODUCTION

Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease worldwide. Endothelin-1 (ET-1) is a potent vasoconstrictor secreted by vascular endothelial cells, actively involved in the pathophysiology of numerous cardiovascular diseases. Based on the differential downstream effects of ET-1 binding to its two distinct types of receptors (ETA/ETB) within the kidney, selective ETA receptor blockade has been long proposed as a promising treatment modality for DKD.

AREAS COVERED

This review aims to examine the available evidence base for the use of ERAs in the treatment of DKD, by critically reappraising available landmark trials and discussing their possible position in the context of current treatment of this disease.

EXPERT OPINION

Despite early enthusiasm and widespread expectations, endothelin receptor antagonists (ERAs) faded into obscurity following the release of the first randomized controlled trials (RCTs). More recent RCTs using different compounds have re-introduced ERAs as a promising treatment in the growing pharmaceutical armamentarium of DKD. While the future of DKD management will be based on a more personalized approach, new, robust evidence from appropriately designed RCTs is eagerly anticipated to clearly define the role of ERAs in DKD.

Carbamylated Albumin, Heart Failure, and Mortality in Patients Undergoing Coronary Angiography

BACKGROUND

Urea is elevated in chronic kidney disease (CKD) and end-stage renal disease (ESRD), and promotes the carbamylation of proteins, including human albumin, on multiple lysine side chains. Higher proportions of carbamylated albumin (C-Alb) have been associated with increased mortality risk in patients with ESRD. Whether C-Alb predicts mortality in patients with no or mild impairment of kidney function is unknown.

METHODS

We measured C-Alb in 3197 participants of the Ludwigshafen Risk and Cardiovascular Health (LURIC) study who had been referred to coronary angiography and followed-up for 10 years. Association of baseline C-Alb with all-cause and cause-specific mortality was investigated using Cox proportional hazards regression.

RESULTS

Higher quartiles of C-Alb were associated with a significantly increased risk of death from any cause, with hazard ratios (HRs, 95%CI) of 1.53 (1.26-1.85) and 2.52 (2.11-3.01) in the third and fourth quartiles, respectively. After adjustment for cardiovascular (CV) risk factors, including estimate glomerular filtration rate (eGFR), the association with mortality was attenuated with a HR of 1.25 (1.02-1.53) for the fourth quartile as compared to the first quartile. We observed the strongest association with death due to congestive heart failure (HF) with a HR of 7.19 (4.57-11.3) and 3.99 (2.40-6.63) per 1-unit increase of log-transformed C-Alb in unadjusted and multivariate adjusted analyses, respectively.

CONCLUSIONS

We observed a strong association of C-Alb with CV risk in patients with no or mild CKD. This association was independent of traditional CV risk factors including eGFR and particularly strong regarding death due to congestive HF.

Intestinal Dysmotility and Associated Disorders in Intestinal Muscle of Methylglyoxal-Treated Mice

BACKGROUND

Peritoneal dialysis (PD) is a renal replacement therapy approach to treat end-stage renal failure. However, complications such as gastrointestinal dysmotility occur in patients undergoing PD, and the mechanisms underlying these complications have not been elucidated. We hypothesized that inflammation and dysfunction of the interstitial cells of Cajal (ICC) contribute to the PD-induced gastrointestinal dysmotility.

METHODS

Mice were intraperitoneally administered a dialysate containing methylglyoxal (40 mM) every other day for 2 weeks to mimic the gastrointestinal complications in patients undergoing long-term PD. The gastrointestinal transit capacity was evaluated using fluorescent dyes that were forcibly administered orally. To evaluate the inflammation and function of the ICC in the intestinal muscles, we performed real-time polymerase chain reaction and immunohistochemical staining and measured spontaneous contractions ex vivo.

KEY RESULTS

The intestinal transit capacity was significantly reduced in the methylglyoxal-treated group compared to that in the control group. In the inflammatory evaluation, the number of neutrophils and macrophages in the intestinal muscles significantly increased in the methylglyoxal-treated group compared to the control group. Moreover, the mRNA expression levels of Tnf, Il1b, and Il6 were upregulated in the intestinal muscle from the methylglyoxal-treated group. The mRNA expression of Kit, an interstitial cell of Cajal marker, was significantly decreased in the methylglyoxal-treated group. In addition, the frequency of spontaneous contractions, an index of ICC function, was decreased in the methylglyoxal-treated group.

CONCLUSIONS AND INFERENCE

Our data suggest that the PD-induced gastrointestinal dysmotility might be due to inflammation and dysfunction of the ICC in intestinal muscles.

J-shaped association between apolipoprotein B and CV outcomes in statin-treated patients with chronic coronary syndrome

INTRODUCTION AND OBJECTIVES

The association between apolipoprotein B (apoB) and residual cardiovascular (CV) risk in patients with chronic coronary syndrome (CCS) remains unclear. We aimed to investigate the association between apoB levels and CV outcomes in statin-treated CCS patients.

METHODS

We enrolled 8641 statin-treated CCS patients at Fuwai Hospital. The patients were divided into 5 groups based on to apoB quintiles (Q1 to Q5). The primary endpoint was 3-year CV events, including CV death, nonfatal myocardial infarction, and nonfatal stroke.

RESULTS

During a median follow-up of 3.17 years, there were 232 (2.7%) CV events. After multivariable adjustment, a restricted cubic spline illustrated a J-shaped relationship between apoB levels and 3-year CV events, with the risk remaining flat until apoB levels exceeded 0.73g/L, after which the risk increased (nonlinear P <.05). Kaplan-Meier curves showed the lowest CV event rate in the Q3 group (0.68-0.78g/L). Compared with the Q3 group, multivariable Cox regression models revealed that both low (Q1, ≤0.57g/L) and high (Q5, >0.93g/L) apoB levels were associated with an increased risk of major adverse cardiac events (all P <.05). Notably, patients with low apoB levels (Q1) had the highest risk of CV death (HR, 2.44; 95%CI, 1.17-5.08).

CONCLUSIONS

Our analysis indicates that both low and high levels of apoB are associated with elevated CV risk, with the risk being particularly pronounced at higher levels (> 0.73g/L).

Hair Loss in a Hemodialysis Patient after Repetitive Use of the Antipruritic Drug Nalfurafine: Implications of Impaired Angiogenesis for Hair Loss

A 47-year-old man who presented with scalp hair loss was transferred to our dialysis facility 3 months after hemodialysis initiation. He noticed systemic hair loss one month after the initiation of dialysis. Because the antipruritic drug nalfurafine was the only drug that had been newly added to his regular medication after he started hemodialysis, we stopped its prescription. His hair loss was completely ameliorated for the next five months. We speculated that κ-opioid receptor activation by nalfurafine caused blood capillary regression around the hair follicles, leading to cessation of hair growth and subsequent hair fallout.

Metabolomics Based Exploration of the Mechanism of Action of Tripterygium Glycosides in Diabetic Kidney Disease

Tripterygium glycosides (TGs), the primary active components of Tripterygium wilfordii, have demonstrated therapeutic efficacy in treating diabetic kidney disease (DKD). However, the precise mechanisms underlying their action remain elusive, limiting the full realization of their medicinal potential. This study employed serum metabolomics based on liquid chromatography-mass spectrometry (LC-MS) analysis to elucidate the mechanisms by which TGs combat DKD. We evaluated the protective effects of TGs on DKD following treatment. Serum samples were collected before and after treatment, and their metabolic profiles were analyzed using LC-MS. Our metabolomics analysis revealed that TGs significantly modulated the hedgehog signaling pathway, a key metabolic pathway implicated in DKD pathogenesis. This study represents the first comprehensive investigation of the metabolic pathways regulated by TGs in the context of DKD using a metabolomics approach. Our findings provide a robust theoretical foundation for the more effective utilization and potential combination therapies involving TGs in the management of DKD. These insights pave the way for further research and development of targeted therapeutic strategies for this challenging condition.

Risk-directed management of chronic kidney disease

The timely and rational institution of therapy is a key step towards reducing the global burden of chronic kidney disease (CKD). CKD is a heterogeneous entity with varied aetiologies and diverse trajectories, which include risk of kidney failure but also cardiovascular events and death. Developments in the past decade include substantial progress in CKD risk prediction, driven in part by the accumulation of electronic health records data. In addition, large randomized clinical trials have demonstrated the effectiveness of sodium-glucose co-transporter 2 inhibitors, glucagon-like peptide 1 receptor agonists and mineralocorticoid receptor antagonists in reducing adverse events in CKD, greatly expanding the options for effective therapy. Alongside angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, these classes of medication have been proposed to be the four pillars of CKD pharmacotherapy. However, all of these drug classes are underutilized, even in individuals at high risk. Leveraging prognostic estimates to guide therapy could help clinicians to prescribe CKD-related therapies to those who are most likely to benefit from their use. Risk-based CKD management thus aligns patient risk and care, allowing the prioritization of absolute benefit in determining therapeutic selection and timing. Here, we discuss CKD prognosis tools, evidence-based management and prognosis-guided therapies.

Advances and challenges in kidney fibrosis therapeutics

Chronic kidney disease (CKD) is a major global health burden that affects more than 10% of the adult population. Current treatments, including dialysis and transplantation, are costly and not curative. Kidney fibrosis, defined as an abnormal accumulation of extracellular matrix in the kidney parenchyma, is a common outcome in CKD, regardless of disease aetiology, and is a major cause of loss of kidney function and kidney failure. For this reason, research efforts have focused on identifying mediators of kidney fibrosis to inform the development of effective anti-fibrotic treatments. Given the prominent role of the transforming growth factor-β (TGFβ) family in fibrosis, efforts have focused on inhibiting TGFβ signalling. Despite hopes raised by the efficacy of this approach in preclinical models, translation into clinical practice has not met expectations. Antihypertensive and antidiabetic drugs slow the decline in kidney function and could slow fibrosis but, owing to the lack of technologies for in vivo renal imaging, their anti-fibrotic effect cannot be truly assessed at present. The emergence of new drugs targeting pro-fibrotic signalling, or enabling cell repair and cell metabolic reprogramming, combined with better stratification of people with CKD and the arrival of nanotechnologies for kidney-specific drug delivery, open up new perspectives for the treatment of this major public health challenge.

The health-economic impact of urine albumin-to-creatinine ratio testing for chronic kidney disease in Japanese non-diabetic patients

BACKGROUND

The objective of this analysis was to estimate the clinical and economic impact of undertaking urine albumin-to-creatinine ratio (UACR) testing alongside regular estimated glomerular filtration rate testing for chronic kidney disease in non-diabetic Japanese patients versus no testing and versus urine protein-creatinine ratio (UPCR) testing.

METHODS

An economic model, taking a Japanese healthcare perspective, estimated the health-economic impact of UACR testing over a lifetime time horizon. Outcomes reported were additional costs, clinical benefits measured, such as prevented dialyses and cardiovascular events, quality-adjusted life years gained, and incremental cost-effectiveness ratios. Health states were derived from risk levels reported in the Kidney Disease: Improving Global Outcomes heatmap. Results were derived assuming that after testing, treatment was available in the form of current standard-of-care or emerging chronic kidney disease therapies.

RESULTS

Repeated UACR testing was found to be cost-effective compared to both no urine testing and UPCR testing, with incremental cost-effectiveness ratios of ¥1,953,958 and ¥1,966,433, respectively.

CONCLUSION

Overall, this model demonstrates the health-economic value of undertaking UACR testing within the non-diabetic Japanese population.

Prevalence of Severe Mental Illness and Its Associations With Health Outcomes in Patients With CKD: A Swedish Nationwide Study

RATIONALE & OBJECTIVE

Patients with chronic kidney disease (CKD) often face mental health problems, but the burden of severe mental illness (SMI) in this population is unclear. We estimated the prevalence of SMIs among people with CKD and their associations with health outcomes.

STUDY DESIGN

Nationwide cross-sectional and cohort study.

SETTING & PARTICIPANTS

Using the Swedish Renal Registry, we identified 32,943 patients with incident CKD G3b-5 or kidney replacement therapy (KRT) between 2008 and 2020 for estimation of the prevalence of SMIs. Data about the 30,103 patients not receiving KRT were used to examine associations between SMIs and subsequent health outcomes.

EXPOSURE

Occurrence of SMIs (ie, schizophrenia, bipolar disorder, and major depressive disorder) before the date of first registration into the registry (index date), using diagnoses from inpatient or specialist outpatient care.

OUTCOME

30% decline in eGFR, initiation of KRT, and all-cause mortality.

ANALYTICAL APPROACH

Prevalence of SMIs was estimated in patients with CKD and compared with the general population using standardization with ratios adjusted for age, sex, and calendar year. Associations between SMIs and health outcomes were examined using Cox proportional hazards models.

RESULTS

The overall prevalence of SMI was 7.3% in patients with CKD, which was 56% higher than the general population. The prevalences for schizophrenia, bipolar disorder, and major depressive disorder were 0.5%, 2.1%, and 5.6%, respectively. All 3 SMIs were associated with a higher mortality rate. Schizophrenia was not associated with 30% decline in eGFR (HR, 0.92 [95% CI, 0.65-1.29]), but it was associated with a lower rate of initiating KRT (HR, 0.56 [95% CI, 0.39-0.80]). Bipolar disorder was associated with a higher rate of 30% decline in eGFR (HR, 1.47 [95% CI, 1.29-1.67]) but a lower rate of initiating KRT (HR, 0.79 [95% CI, 0.67-0.94]). Major depressive disorder was not associated with 30% decline in eGFR or initiation of KRT.

LIMITATIONS

Lack of primary care data and exclusion of individuals with CKD G1-3a.

CONCLUSIONS

Patients with CKD had a higher prevalence of SMI compared with the general population. In patients with CKD, each SMI was associated with higher mortality, and bipolar disorder was associated with a faster eGFR decline. Patients with CKD and pre-existing schizophrenia or bipolar disorder experienced a lower rate of initiating KRT.

PLAIN-LANGUAGE SUMMARY

Patients with chronic kidney disease (CKD) frequently experience mental health problems, yet the prevalence and impact of severe mental illness (SMI) in this population remain uncertain. This Swedish nationwide study revealed that the prevalence of any SMI was 7.3% among patients with CKD (0.5% for schizophrenia, 2.1% for bipolar disorder, and 5.6% for major depressive disorder), representing a 56% higher prevalence than experienced by the Swedish general population. All 3 SMIs were associated with a higher mortality rate in patients with CKD, and bipolar disorder was also associated with a faster eGFR decline. Moreover, patients with CKD and schizophrenia or bipolar disorder exhibited a lower rate of initiating kidney replacement therapy. These findings highlight the need for improved recognition and management of SMI among people with kidney disease.

Enhanced Stroke Risk Stratification Using Triglyceride-Glucose-Waist Circumference in Chinese Adults Without Diabetes

INTRODUCTION

Insulin resistance is a well-establsihed risk factor for stroke. However, the relationship between triglyceride-glucose (TyG) index; its modified indices‒TyG-waist circumference (TyG-WC); TyG-waist-to-height ratio (TyG-WHtR); and TyG-BMI and the risk of stroke in populations without diabetes remains underexplored.

METHODS

Data from the CHARLS on 4,029 participants without diabetes aged 45+ years at baseline (2011‒2012) were analyzed, with follow-ups through 2020. Statistical analysis and modeling were performed in 2024. Incident strokes occurring between 2015 and 2020 were examined. TyG and its modified indices were categorized into tertiles and analyzed based on baseline levels, changes over time, and cumulative measures. Changes in TyG and its modified indices were identified using K-means clustering, while cumulative indices were calculated using a formula: (TyG2012+TyG2015)/2 × time (2015-2012).

RESULTS

Between 2015 and 2020, 225 participants (5.6%) experienced a stroke. After full adjustment, for cofounders only TyG-WC remained significantly associated at each level across its baseline levels, changes, and cumulative measures (p<0.05), outperforming TyG, TyG-WHtR and TyG-BMI. Compared to Tertile 1, AORs (95% CIs) for stroke associated with TyG-WC were 1.64 (1.10, 2.47) in Tertile 2 and 1.79 (1.15, 2.82) in Tertile 3. For changes in TyG-WC, ORs (95% CIs) were 1.70 (1.14, 2.60) in Class 2 and 1.80 (1.11, 2.97) in Class 3. Regarding cumulative TyG-WC, the ORs (95% CIs) were 1.61 (1.08, 2.41) for Tertile 2 and 1.70 (1.10, 2.66) for Tertile 3. Additionally, TyG-WC demonstrated superior predictive performance for stroke compared to other indices.

CONCLUSIONS

TyG-WC is strongly associated with stroke risk in populations without diabetes, offering superior risk stratification compared to other TyG indices.

Strategies to Prevent Hemodialysis Catheter Dysfunction

Millions of patients with kidney failure rely on hemodialysis central venous catheters (CVCs) for their life-sustaining dialysis treatments. CVC dysfunction necessitates removal of up to 20% of CVCs and is an important problem for patients with kidney failure. Thrombosis and fibrin sheath formation are the most common mechanisms of CVC dysfunction beyond the first week after insertion. Factors such as female sex, left-sided CVC placement, and prior CVC dysfunction are associated with a higher risk of dysfunction. Patient-specific factors contribute substantially to variation in the number of CVC dysfunction events. Weekly thrombolytic locks have been shown to improve CVC blood flow rates, prevent infection, and reduce dysfunction requiring removal. However, routine administration may not be cost-effective in hemodialysis units with low infection rates, and targeted use among patients with established CVC dysfunction has not been studied. Concentrated heparin lock ( e.g ., 5000 versus 1000 international unit/ml) has been associated with lower requirements for therapeutic CVC thrombolysis but greater systemic bleeding risks and costs. Citrate 4% was noninferior to standard heparin locks to prevent thrombosis, may cause less bleeding, and is less costly in some countries. Tunneled CVCs with a symmetrical tip have been associated with a lower risk of CVC dysfunction compared with those with a step tip. Multifaceted CVC care interventions can reduce the incidence of dysfunctional CVCs by 33% compared with usual care. Future research to identify patients at high risk of CVC dysfunction will inform individualized vascular access plans, targeted use of preventive strategies, and enrollment criteria for future clinical trials.

Raspberry ameliorates renal fibrosis in rats with chronic kidney disease via the PI3K/Akt pathway

BACKGROUND

Renal fibrosis is a hallmark of chronic kidney disease (CKD). In traditional Chinese medicine, Rubus chingii Hu (raspberry) is believed to have kidney-tonifying properties. However, whether raspberry can effectively treat CKD, along with the specific active compounds and underlying mechanisms, remains unclear.

PURPOSE

This study aims to investigate the potential of raspberries in treating CKD and elucidate the mechanisms involved.

METHODS

CKD model was established in rats using adenine. The effects of raspberry treatment on CKD were assessed through macroscopic observations and pathological changes in the kidney. The expression of fibrotic proteins in renal tissues was analyzed to evaluate the impact of raspberry on renal fibrosis. Data mining combined with compositional analysis were employed to identify the active ingredients, targets, and pathways of raspberry that may improve CKD. Subsequently, Western blotting and immunofluorescence analysis were conducted to confirm the involvement of the PI3K/AKT signaling pathway in the renoprotective mechanism of raspberry.

RESULTS

Raspberry treatment significantly alleviated renal pathological damage, fibrosis and inflammation in model rats, showing effects comparable to irbesartan (Avapro). Chemical composition analysis and network pharmacology predicted AKT1 as the core target, and the PI3K/AKT pathway plays a pivotal role in mediating the therapeutic effects of raspberry extract in CKD. Molecular docking studies further confirmed that active compounds in raspberry have a strong binding affinity with AKT1. Western blotting and immunofluorescence results demonstrated that raspberry inhibited phosphorylation, thereby suppressing the PI3K/AKT pathway, leading to its antifibrotic effect on the kidney.

CONCLUSION

Raspberry was firstly discovered to potentially treat CKD by alleviating renal fibrosis through inhibition of the PI3K/AKT pathway. Raspberry, as a medicinal and edible traditional herb, could serve as a promising therapeutic agent or health supplement for improving renal fibrosis and slowing CKD progression.

Hypomagnesemia induces impaired glucose metabolism and insulin resistance in patients with Gitelman syndrome

AIMS

To investigate the contributing factors of impaired glucose metabolism in patients with Gitelman syndrome (GS).

METHODS

This study collected clinical data and conducted oral glucose tolerance tests (OGTT) on 44 GS patients, with 60 non-functioning adrenal incidentaloma (NFAI) patients serving as controls.

RESULTS

Compared to NFAI patients, GS patients exhibited a significantly higher prevalence of impaired glucose metabolism (P < 0.001), with markedly higher homeostasis model assessment of insulin resistance (HOMA-IR), lower quantitative insulin sensitivity check index, and lower Matsuda index compared to NFAI patients (all P < 0.001). The homeostasis model assessment for β cells was elevated (P = 0.003) and the insulin secretion sensitivity index-2 was reduced (P = 0.007) in GS patients relative to NFAI patients. Logistic regression identified hypomagnesemia (P = 0.042) and hypokalemia (P = 0.046) as risk factors for dysregulated glucose metabolism in GS patients. Additionally, higher body mass index (BMI) (P = 0.016) and hypomagnesemia (P = 0.045) were significant contributors to IR. Notably, GS patients had a steeper linear regression slope between BMI and HOMA-IR compared to NFAI patients (P = 0.016). A negative linear correlation between plasma magnesium and BMI (R = 0.54, P < 0.001) was found in GS patients.

CONCLUSIONS

Hypomagnesemia may contribute to increased BMI, exacerbating impaired glucose metabolism and IR in GS patients.

Microdose Cocktail Study Reveals the Activity and Key Influencing Factors of OATP1B, P-Gp, BCRP, and CYP3A in End-Stage Renal Disease Patients

OATP1B, P-gp, BCRP, and CYP3A are the most contributing drug-metabolizing enzymes or transporters (DMETs) for commonly prescribed medication. Their activities may change in end-stage renal disease (ESRD) patients with large inter-individual variabilities (IIVs), leading to altered substrate drug exposure and ultimately elevated safety risk. However, the changing extent and indictive influencing factors are not quantified so far. Here, a microdose cocktail regimen containing five sensitive substrate drugs (pitavastatin, dabigatran etexilate, rosuvastatin, midazolam, and atorvastatin) for these DMETs was administrated to Chinese healthy volunteers and ESRD patients. Drug pharmacokinetics profiles were determined, together with physiological, pharmacogenetic, and gut microbiome signature. Population pharmacokinetic and machine learning model were established to identify key influencing factors and quantify their contribution to drug exposure change. The exposure of pitavastatin, dabigatran, rosuvastatin, and atorvastatin increased to 1.8-, 3.1-, 1.1-, and 1.3-fold, respectively, whereas midazolam exposure decreased by 72% in ESRD patients. Notably, in addition to disease state, the relative abundance of genus Veillonella and Clostridium_XIVb were firstly identified as significant influencing factors for PTV and RSV apparent clearance, respectively, suggesting their indicative role for OATP and BCRP activity evaluation. Moreover, several genera were found to strongly associate with drug clearance and reduce unexplained IIVs. Accordingly, it was estimated that OATP1B and intestine P-gp activity decreased by 35-75% and 29-44%, respectively, whereas BCRP and CYP3A4 activity may upregulate to some extent. Our study provides a quantitative and mechanistic understanding of individual DMET activity and could support precision medicine of substrate drugs in ESRD patients.

Heparin and heparin-like modifications in hemodialysis membranes: Current innovations and future directions

Heparinized hemodialysis membranes represent a significant advancement in improving the biocompatibility and anticoagulant properties of dialysis treatments. This review explores the current challenges and innovations in developing these membranes, focusing on the incorporation of heparin and heparin-like substances to reduce protein adsorption, platelet adhesion, and clot formation. The methods for heparin immobilization, including covalent bonding, layer-by-layer assembly, and blending, offer promising results in enhancing membrane performance. However, issues such as long-term stability, large-scale production, and cost-effectiveness remain critical barriers to their widespread adoption. The review also highlights the role of surface activation techniques and nanotechnology in improving the functionality of heparinized membranes. Advanced methods like plasma treatment and polymer grafting provide better heparin attachment, while nanomaterial integration allows for improved blood compatibility and controlled heparin release. Despite these innovations, challenges such as heparin degradation, uneven coating, and the complexity of scaling up remain unresolved. Future research should focus on optimizing heparin distribution, enhancing durability, and making the production process more cost-efficient. This paper outlines potential interdisciplinary approaches, such as bioinspired materials and nanotechnology applications, to address these challenges and pave the way for next-generation hemodialysis membranes that are safer, more effective, and more accessible.

Rosiridin prevents cisplatin-induced renal toxicity by inhibiting caspase-3/NF-κB/ Bcl-2 signaling pathways in rats and in silico study

The present investigation determines the effects of rosiridin in cisplatin (CP)-induced renal toxicity in rats. The experimental animals were used and divided into four groups. Experimental rats were randomly divided into group-I normal control, group-II CP group (8 mg/kg i.p.), group-III CP + rosiridin (10 mg/kg, p.o.) and group-IV rosiridin (10 mg/kg p.o.). Various biochemical parameters, i.e., creatinine, urea, uric acid, cholesterol, blood urea nitrogen, antioxidant levels, inflammatory markers such as interleukins-1β (IL-1β), IL-6, tumor necrosis factor-α (TNF-α), nuclear factor kappa B (NF-κB), apoptosis markers including B cell lymphoma-2 (Bcl-2), caspase-3 and histopathological investigations were evaluated. Additionally, molecular docking and dynamics were performed to assess the interaction of rosiridin with target proteins. Rosiridin significantly minimized alteration in creatinine, urea, uric acid, cholesterol, blood urea nitrogen, antioxidant levels, and inflammatory, i.e., IL-1β, IL-6, TNF-α, NF-κB, Bcl-2, and caspase-3 which CP induced in rats. The interaction of rosiridin showed a favorable docking energy. The MD simulation results showed the higher stability of the complex generated from rosiridin. The current study exhibited rosiridin having a protective effect on CP-induced renal toxicity.

SYSTEMATIC REVIEW AND META-ANALYSIS OF OPTICAL COHERENCE TOMOGRAPHY MEASUREMENTS IN PATIENTS WITH CHRONIC KIDNEY DISEASE

PURPOSE

To assess neurodegeneration and chorioretinal thickness in subjects with and without chronic kidney disease (CKD).

METHODS

PubMed, Web of Science, Scopus, and Embase were searched using proper keywords for articles published in the English language from their inception until January 2024. Publications were included if they reported optical coherence tomography measurements of retinal or choroidal layers in patients with CKD compared with healthy or non-CKD controls. We used a random-effects model to calculate pooled standardized mean difference (SMD) estimates and 95% confidence intervals (CIs).

RESULTS

Twelve studies, with 29,340 patients, were included in quantitative synthesis. In comparison to controls, patients with CKD had a significantly lower value for average retinal thickness (SMD [CI], -0.35 [-0.58 to -0.12], P = 0.028), choroidal thickness (SMD [CI], -1.84 [-4.17 to 0.49], P = 0.122), macular ganglion cell-inner plexiform layer (SMD [CI], -0.58 [-0.78 to -0.38]], P < 0.001), and peripapillary retinal nerve fiber layer thickness (SMD [CI], -0.32 [-0.44 to -0.20], P < 0.001). Significant retinal nerve fiber layer thinning was observed in both diabetic CKD excluded and not excluded subgroups.

CONCLUSION

Compared with controls, the eyes of patients with CKD have significantly thinner retina, ganglion cell-inner plexiform layer, and retinal nerve fiber layer.

Efficacy and Safety of Phosphate-Lowering Agents for Adult Patients with CKD Requiring Dialysis: A Network Meta-Analysis

Key Points

Background

It is necessary to update the evidence of each phosphate-lowering agent on dialysis patients.

Methods

From the CENTRAL, MEDLINE, Embase, and ClinicalTrial.gov databases, randomized controlled trials using oral phosphate-lowering agents on adult patients requiring maintenance dialysis were extracted. The treatment period was required for 8 or more weeks, and the risk of bias was assessed according to the Cochrane Collaboration method. The outcomes were all-cause mortality, cardiovascular mortality, gastrointestinal events, fracture, coronary artery calcium score (CACS), serum calcium, phosphate, intact parathyroid hormone, and bicarbonate levels. A network meta-analyses using multivariate random-effects models were performed for assessing the comparative effectiveness. The ranking of the phosphate-lowering agents was assessed using a surface under the cumulative ranking curve.

Results

A total of 70 randomized controlled trials involving 15,551 participants were included. Eleven phosphate-lowering agents including calcium-based agents, sevelamer, bixalomer, lanthanum, sucroferric oxyhydroxide, ferric citrate, tenapanor, magnesium, nicotinamide, aluminum, and sucralfate were assessed. Sevelamer was significantly associated with lower all-cause mortality compared with calcium-based agents (risk ratio [95% confidence interval]: 0.59 [0.37 to 0.94]), and sucroferric oxyhydroxide and tenapanor were estimated to rank high in lowering all-cause mortality on the basis of the surface under the cumulative ranking curve. The risk of gastrointestinal events was the highest with nicotinamide, followed by sucroferric oxyhydroxide. Compared with calcium-based agents, CACS was significantly lower among those on lanthanum and sucroferric oxyhydroxide (standardized mean difference [95% confidence interval]: −0.26 [−0.52 to −0.01] and −0.50 [−0.95 to−0.06], respectively). Serum calcium levels were higher, and serum intact parathyroid hormone levels were lower in patients treated with calcium-based agents. Except for sevelamer, serum bicarbonate levels for all other agents were higher compared with placebo.

Conclusions

Compared with calcium-based agents, sevelamer was associated with lower all-cause mortality, and sucroferric oxyhydroxide and lanthanum were associated with slower progression of CACS. Potential benefits and harms should be considered when selecting phosphate-lowering agents (International prospective register of systematic reviews: CRD42022328388).

Comparison of mini-percutaneous nephrolithotomy and standard percutaneous nephrolithotomy in the treatment of renal calculi with renal insufficiency

To compare the clinical efficacy and safety of mini-percutaneous nephrolithotomy (MPCNL) and standard percutaneous nephrolithotomy (SPCNL) in the treatment of kidney stones combine with renal insufficiency. The data of 320 patients with renal calculi and an eGFR < 60 mL/min/1.73m2 who underwent percutaneous nephrolithotomy (PCNL) at Zhongshan City People's Hospital from January 2018 to June 2023 were retrospectively analyzed; 164 patients were treated with MPCNL, and 156 were treated with SPCNL. The clinical efficacy of the MPCNL and SPCNL regimens was compared in terms of stone-free rate (SFR), renal function change, hemoglobin (HGB) drop and other complication rates (complications were classified by using the Clavien‒Dindo system). The SFR was 67.1% in the MPCNL group and 67.9% in the SPCNL group (P = 0.867). The overall eGFR of the two groups was significantly improved at 1 month after the operation (P < 0.001). Postoperative renal function was stable, improved and worse in 50.0% (n = 82) vs. 53.8% (n = 84), 39.0% (n = 64) vs. 42.4% (n = 66) and 11.0% (n = 18) vs. 3.8% (n = 6) of the MPCNL and SPCNL patients, respectively, compared with preoperative renal function (P = 0.053). In addition, the overall postoperative complication rates between the two groups was not significantly different (P = 0.103). Patients who underwent MPCNL had a lower transfusion rate (7.9% vs. 16.7%, P = 0.017) and shorter hospital stay (4.57 ± 3.14 vs. 7.16 ± 4.05 days, P < 0.001) than those in the SPCNL group. MPCNL and SPCNL have positive effects on the treatment of renal calculi in patients with renal insufficiency; both have acceptable SFRs and complication rates, stable or improved renal function in most patients.

Noninvasive Diagnosis of Early-Stage Chronic Kidney Disease and Monitoring of the Hemodialysis Process in Clinical Practice via Exhaled Breath Analysis Using an Ultrasensitive Flexible NH3 Sensor Assisted by Pattern Recognition

To achieve the early diagnosis of chronic kidney disease (CKD), noninvasive hemodialysis monitoring, and accurate determination of dialysis duration and adequacy, a noninvasive, point-of-care, user-friendly device should be developed. Here, a flexible, room temperature NH3 gas sensor sensitive to the key breath biomarkers of CKD─NH3 and creatinine─was fabricated. The sensor had detection limits of 100 ppb for NH3 and 1 ppm for creatinine. Clinically, a total of 96 exhaled breath samples, half from 39 CKD patients and the other half from 48 healthy controls were collected and analyzed. With the assistance of a pattern recognition algorithm , the early diagnosis of CKD was achieved by the sensor, with PCA being used due to sensor's cross-sensitivity to CKD biomarkers. Diagnostic models distinguishing CKD versus non-CKD and early-stage CKD versus advanced-stage CKD were constructed using the SVM algorithm, achieving an overall accuracy of 0.93 and 0.94, with area under the curve (AUC) values of 0.97 and 0.99 for all subjects in receiver operating characteristic (ROC) analysis, respectively. The hemodialysis processes of patients were monitored in real-time, with the sensor response values exhibiting ideal exponential decay over time. The sensor response values showed a strong positive correlation with serum creatinine levels (r = 0.85) and a moderate positive correlation with blood urea nitrogen levels (r = 0.62), both of which are key clinical diagnostic indicators for CKD. These are good results, as 54% of CKD samples are from early-stage CKD patients. These results suggest that the sensor could serve as a noninvasive alternative to traditional blood tests for renal function evaluation and CKD diagnosis. Overall, this sensor demonstrates great potential in clinical practice for early diagnosis of CKD, monitoring the daily health status of CKD patients, optimizing the dialysis schedule, and monitoring the dialysis process in real-time.

Morphometric study of proximal tubular cell mitochondria using TEM images in renal diseases

The kidney is rich in mitochondria, and any alterations or damage to tubular cell mitochondria play an important role in renal metabolic activities and the pathogenesis of various kidney diseases. Quantitative analysis of mitochondrial concentration, size, and shape is essential for understanding mitochondrial biology in renal disorders. This study assessed mitochondrial morphometric parameters of the proximal convoluted tubular cell adjacent to the glomerulus in different renal disorders and investigated how they correlated with serum creatinine. A total of 65 kidney biopsy cases received by the transmission electron microscope (TEM) laboratory for diagnosis were included in the study. TEM images of glutaraldehyde-osmium tetroxide fixed epoxy-resin embedded 70 nm thick sections were used for the evaluation of (i) minor axis(MinX) (ii) major axis(MajX) (iii) Area, (iv)Perimeter, (v) Aspect ratio and (vi) Roundness of mitochondria in renal tubular cells using QuPath software. Mitochondrial density (MDensity), % of mitochondrial space (MSpace), and mitochondrial surface density (MSDensity) in the cytoplasm of tubular space were estimated for each sample. Serum creatinine showed good negative correlations with MSpace and MSDensity, and elongation of mitochondria was more in renal disorder in comparison to normal histology, which indicated the variation of mitochondrial concentration and shape in proximal tubular cells could be important features in the renal function disorder.

A review of technical steps in the performance of arteriovenous fistula creation

Although it is accepted that a functional arteriovenous fistula (AVF) is the optimal vascular access for dialysis, achieving function is difficult as the outcomes of AVF creation are sub-optimal. Many technical steps have been proposed to improve outcomes, but the strength of evidence to support these is unclear. Thus, a systematic review of all randomised controlled trials (RCT) of operative strategies to optimise AVF outcomes was performed to summarise the evidence, review the overall level of standardisation in RCT and thus determine if there was an objective basis for the technical steps in AVF creation. A systematic review of all RCT was performed and studies categorised by intervention type. The rationale for each intervention, outcomes and limitations were described. Most importantly, the completeness of reporting procedural steps was compared for all RCT and the therapeutic impact considered by AVF site. Of 6741 records meeting the search criteria, 31 RCT were included. Most RCT did not control for all technical aspects or fully detail the operative methods, with a mean of 4 technical steps not reported for which other RCT have been performed. Of studies involving a surgical intervention in RCF, 10/13 reported a significant benefit compared to only 5/15 studies in BCF or larger vessels. Overall, the adequacy of reporting the technical details in all RCT of technical steps in AVF creation was poor. Despite this, there was a consistent patency benefit found in RCT performed in smaller vessels although the extent of interaction between these is uncertain. There remain gaps in the literature in defining the optimal steps in fistula creation that, if confirmed, could significantly improve AVF outcomes. This makes it essential that future studies of novel techniques, such as percutaneous AVF creation, incorporate a standardised operating procedure of optimal current practice of surgically created AVF as a meaningful comparator.

Haemostatic changes detected by thromboelastography in chronic kidney disease: A systematic review and meta-analysis

Haemostasis in Chronic Kidney Disease (CKD) is complex, with patients experiencing both thrombotic and haemorrhagic risks. Current therapies, such as dialysis and blood transfusions, often rely on clinical judgment, which may not fully address these haemostatic abnormalities. This systematic review and meta-analysis aimed to determine whether Thromboelastography (TEG) offers a better ability to assess coagulation abnormalities in CKD compared to standard coagulation tests like activated partial thromboplastin time (aPTT), and prothrombin time (PT). A search across five databases identified 10 studies comparing TEG parameters in CKD patients versus healthy controls. TEG detected hypercoagulability in CKD, with significant reductions in Kinetics Time (P = 0.04), increases in Alpha angles (P = 0.02), and elevated Maximum Amplitude values (P = 0.0006). However, Reaction Time (P = 0.43) and Lysis 30 (P = 0.28) showed no significant differences. Standard coagulation tests, including aPTT and PT, also showed no significant differences between groups (P = 0.30 and P = 1.00), suggesting their limitations in detecting the complex haemostatic changes in CKD. Platelet counts were lower in CKD patients (P = 0.0009) but remained within normal ranges. Elevated fibrinogen levels (P = 0.003), linked to chronic inflammation, indicated a prothrombotic profile. Despite high heterogeneity in some parameters due to variability in CKD stages and treatment types, TEG demonstrates a more detailed assessment of haemostatic changes in CKD, suggesting its potential as a predictive tool for managing coagulation abnormalities.

Efficacy and safety of endothelin receptor antagonists in non-diabetic kidney nephropathy : A systematic review and meta-analysis

BACKGROUND

Recent evidence increasingly confirms the therapeutic potential of endothelin receptor antagonists (ERA) in treating non-diabetic kidney nephropathy. However, clinical data in this area remain limited. Therefore, we conducted this meta-analysis to investigate the efficacy and safety of ERAs in the treatment of non-diabetic kidney nephropathy.

METHODS

Randomized controlled trials were identified through PubMed, WOS, Embase, Cochrane Library and Google scholar. The initial participant characteristics and primary outcome measures were gathered, followed by the calculation of risk ratios (RR) and 95% confidence intervals (CI). Additionally, subgroup analyses were conducted to investigate the sources of heterogeneity.

RESULT

In this study, seven randomized, controlled trials (RCT) were included. The results indicated that patients in the ERAs group exhibited a greater mean reduction in the urinary protein to creatinine ratio (UPCR) (standardized mean difference, MD -28.08, 95% CI -33.59 to -22.57, p < 0.001). The number of patients experiencing either complete or partial remission from proteinuria notably increased when treated with ERAs (complete remission: odds ratio, OR = 3.14, 95% CI 2.23-4.42, p < 0.001; partial remission: OR = 3.03, 95% CI 2.33-3.96, p < 0.001). Furthermore, ERAs delayed the decline in the estimated glomerular filtration rate (eGFR, MD = 3.81, 95% CI 1.71-5.90, p < 0.001). However, the incidence of edema events slightly increased in the ERA group (OR = 1.42, 95% CI 1.04-1.93, p = 0.03).

CONCLUSION

The use of ERAs is more effective than regimens without ERAs in slowing the progression of non-diabetic nephropathy.

A Phase I Study to Evaluate the Pharmacokinetics and Safety of TPN171 (a PDE5 Inhibitor) in Adults with Renal Impairment

TPN171, a phosphodiesterase 5 inhibitor, is under development for the treatment of male erectile dysfunction and pulmonary arterial hypertension in China. To investigate the pharmacokinetic properties and safety of TPN171 in individuals with severe renal impairment and normal renal function, an open-label, single-dose, parallel-group phase 1 study was conducted in 8 participants with severe renal impairment (glomerular filtration rate within 15-29 mL/min) and 8 participants having normal renal function, who received TNP171 tablets (10 mg) in the fasting state. As compared with those with normal renal function, the geometric mean ratios for maximum plasma concentration (Cmax), the area under the plasma concentration-time curve from time zero to the last quantifiable concentration (AUC0-t), and AUC extrapolated to infinite time (AUC0-∞) were 74.3%, 138%, and 137%, respectively. Elimination half-life was prolonged and clearance was decreased in severe renal impairment group. The adverse reaction rate showed no significant difference. All adverse events were mild intensity, and no participant was discontinued in this study. In conclusion, TPN171 can be cautiously used in patients with mild to severe renal impairment.

Global trends and disparities in the burden of heart failure caused by chronic kidney disease: an analysis of the global burden of disease study 2021

Background

Heart failure (HF) is a major public health concern, and chronic kidney disease (CKD) plays a significant role in its pathogenesis. Understanding the trends and disparities in the burden of HF caused by CKD can provide valuable insights into health policymaking.

Methods

This study was a secondary analysis based on previously published data. We obtained global, regional, national, and age- and sex-specific data on the prevalence and years lived with disability (YLDs) of HF caused by CKD from the Global Burden of Disease Study 2021 (GBD 2021) and performed a secondary comparative analysis by age, sex, time, location, sociodemographic index (SDI), and health system level.

Results

In 2021, there were 1,936.9 (95%UI: 1,600.2-2,343.5) thousand cases of HF caused by CKD globally, with an age-standardized rate of YLDs of 3.1 (95%UI: 1.9-4.4) per 100,000 population. The global burden of HF caused by CKD has continuously increased from 1990 to 2021 and is expected to keep growing through 2045 according to predictions. Significant disparities were found across different locations, genders, and ages. Higher burdens were noted among males, older individuals, and regions with lower SDI or less advanced health systems.

Conclusion

The burden of HF caused by CKD has increased significantly since 1990 and varies widely across regions. More significant efforts are needed in the prevention and treatment of CKD and HF, especially among older individuals and males in regions with lower SDI or less advanced health systems.

Exploring the Relationship Between Immune Cells and Chronic Kidney Disease by Mendelian Randomization, Colocalization Analysis, and SMR

Background: Chronic kidney disease (CKD) impacts millions of individuals annually. Current research suggests that immune factors played a significant role in CKD. However, the potential causal relationship between them remains unclear. Methods: We conducted a comprehensive Mendelian randomization (MR) analysis to assess the potential causal association between 731 immune cells and CKD. Sensitivity analysis was performed to test for heterogeneity and horizontal pleiotropy, including the Cochran Q test, leave-one-out test, MR-Egger intercept analysis, and MR-PRESSO test. The bidirectional MR was utilized to investigate the bidirectional relationship between the immune cells and CKD. Multivariable MR was also conducted to mitigate confounding among immune cells. The colocalization analysis was performed to find the key genes of immune cells. We used the Summary data-based MR (SMR) analysis to generate effect estimates between the cis-eQTL and immune cells. The heterogeneity in dependent instruments (HEIDIs) test was used to test the heterogeneity between dependent instrumental variables. Results: We identified 14 potential pathogenic factors and six potential protective factors through the univariable MR. Moreover, we did not find reverse causation by using the bidirectional MR. We finally identified one risk factor and two protective factors after multivariate MR adjustment for effects between immune cells. CD28 on CD28+ CD45RA+ CD8+ T cell could increase the risk of CKD (Pval: 0.033, OR: 1.112, 95% CI: 1.009-1.227). CD11c on myeloid dendritic cell (DC) could decrease the risk of CKD (Pval: 0.02, OR: 0.854, 95% CI: 0.748-0.975). CD45RA on naive CD4+ T cell could decrease the risk of CKD (Pval: 0.026, OR: 0.918, 95% CI: 0.852-0.990). Importantly, we observed no evidence of heterogeneity and pleiotropy, signifying the robustness of our results. BACH2 (PPH4.abf = 0.999, P_SMR: <0.001, P_HIEDI: 0.132) and HLA-G (PPH4.abf = 0.990, P_SMR: <0.001, P_HIEDI: 0.141) shared the same variant with CD28 on CD28+ CD45RA+ CD8+ T cell. PAQR9 (PPH4.abf = 0.992, P_SMR: <0.001, P_HIEDI: 0.215) shared the same variant with CD11c on myeloid DC. Conclusion: MR identified a potential correlation between CKD and immune cells. Colocalization and SMR found the key genes of immune cells. Our findings offer insights into the prevention and management of CKD. However, further investigation is required to elucidate the precise mechanisms underlying this relationship.