The role of medical social workers (MSWs) in managing patients with end-stage kidney disease (ESKD) undergoing hemodialysis remains unknown. This study evaluated the prognostic impact of pre-dialysis MSW support in patients undergoing renal replacement therapy. This retrospective analysis included 257 patients who started hemodialysis at the Nagasaki Harbor Medical Center between 2016 and 2023. Patients were divided into MSW (+) and MSW (-) groups based on whether they received pre-dialysis MSW support. Outcomes were assessed, including unplanned dialysis initiation, length of hospital stay, and post-hemodialysis survival. The MSW (+) group showed a lower rate of unplanned dialysis initiation, shorter hospital stays and improved post-hemodialysis prognosis compared with the MSW (-) group. In the multivariable Cox regression analysis, pre-dialysis MSW support (hazard ratio 0.58, 95% confidence interval 0.34-0.98, p = 0.04) was associated with lower patient mortality in addition to age, male sex, serum albumin levels 1 month before hemodialysis initiation, and serum creatinine levels 1 month before hemodialysis initiation. Stratified analyses showed a marked positive impact of MSW support in patients aged ≥70 years, male sex, living with family, and malnutrition. MSW support facilitated smoother transitions to maintenance hemodialysis centers through pre-settlement dialysis centers, alleviated patient anxiety, and ensured transportation arrangements. This study highlights the critical role of MSWs in improving clinical outcomes for patients with ESKD who are at higher social risks. Future multicenter studies are warranted to validate these findings and enhance their generalizability.

Purpose To quantify ICU fluids for different uses, identify significant fluid sources for volume and chloride load in critically ill adults, and analyze their impact on prognosis. Methods A prospective study was conducted in a 52-bed academic ICU. From May to December 2022, volume intake/output and fluid purpose were recorded for 5 days for all admitted patients. Fluids were categorized into five types. Patients were divided into high and low fluid creep groups by median dosage. Logistic regression was used to analyze the association with Major Adverse Kidney Events by 30 days (MAKE30). Results 1,633 adult critically ill patients with a median age of 67 years and an APACHE II score of 22 were included. Fluid creep, with a median of 802 ml, accounted for 48.4% of daily fluid volume, far more than resuscitation (8.6%) or maintenance/replacement fluid (6.7%). After adjustment for confounders, high fluid creep was associated with a higher incidence of MAKE30 (OR = 1.37) and its components, including in-hospital mortality (OR = 1.49), new renal replacement therapy (OR = 1.83), and persistent renal damage (OR = 1.75). Conclusions Fluid creep is an important source of volume and chloride load in critically ill adults, and high volumes are associated with a higher incidence of MAKE30. Intravenous fluid therapy should be used with caution.

Regional citrate anticoagulation (RCA) is recommended for critically ill patients at high bleeding risk undergoing continuous renal replacement therapy (CRRT). Nafamostat mesylate (NM), a short-half-life serine protease inhibitor, is a popular alternative in East Asia. Direct comparisons of their efficacy and safety are limited. This retrospective single-center study included 81 critically ill patients receiving CRRT with either NM (n = 31) or RCA (n = 50) from January 2022 to January 2023. The primary outcome was filter lifespan. Secondary outcomes included circuit patency, bleeding events, and metabolic complications. The median filter lifespan was significantly shorter in the NM group compared to the RCA group (23.4 vs. 29.6 h, p = 0.02). The NM group also had a higher rate of unplanned circuit discontinuation (52.3 vs. 39.1%, p = 0.03). Multivariable analysis confirmed RCA was independently associated with a lower risk of circuit failure (HR = 0.44, p = 0.03). Although not statistically significant, trends favored NM regarding metabolic safety, with lower incidences of severe metabolic alkalosis (16.1 vs. 36.0%, p = 0.09) and hypocalcemia (9.7 vs. 26.0%, p = 0.13). RCA demonstrated superior anticoagulation efficacy in prolonging filter survival, while NM may offer a more favorable metabolic safety profile. The choice of anticoagulant should be individualized based on efficacy priorities and metabolic risk.

This study investigated the link between the endothelial activation and stress index (EASIX) and acute kidney injury (AKI) development and prognosis in elderly critically ill patients. Using the MIMIC-IV database, we conducted a retrospective cohort study including 12,122 ICU patients aged ≥65 years, of whom 9,124 developed AKI. Patients were divided into three groups based on EASIX scores. We compared the baseline characteristics, mortality rates, and clinical outcomes across groups. Multivariable Cox regression analysis assessed the association between EASIX and AKI development and short-term outcomes, adjusting for confounders. Kaplan–Meier curves and subgroup analyses were performed. Dose-response modeling, threshold effect analysis, and E-value analysis were also conducted. Results showed that patients with the highest EASIX scores had significantly higher mortality rates, with HRs for 28-day mortality of 1.69 (95% CI: 1.47–1.95, p < 0.001), in-ICU mortality of 1.55 (95% CI: 1.34–1.79, p < 0.001), and in-hospital mortality of 1.42 (95% CI: 1.13–1.79, p = 0.003). Kaplan–Meier curves indicated lower survival probabilities with higher EASIX values (log-rank p < 0.001). Dose-response analysis revealed a nonlinear relationship with a threshold effect at an EASIX value of around 175. Subgroup analysis found a significant interaction in the CHF subgroup (p < 0.001), suggesting the increased vulnerability to elevated EASIX. In conclusion, elevated EASIX is significantly associated with AKI development and adverse short-term outcomes in elderly critically ill patients, indicating its potential as an index for identifying high-risk patients.

Renal anemia, a major complication of chronic kidney disease, contributes to increased cardiovascular risk, mortality, and accelerated progression to kidney failure. However, comprehensive bibliometric analyses evaluating global trends, knowledge gaps, and emerging research hotspots in this field remain lacking. This study retrieved publications related to renal anemia from the Web of Science Core Collection (January 1965–November 2024) and conducted data analysis and visualization using VOSviewer, CiteSpace, Pajek, and Origin. The final dataset included 1,664 publications authored by 7,534 researchers from 2,287 institutions across 72 countries, with Japan, the United States, and China accounting for 45.8% of total publications. Top institutions were Showa University, the University of Tokyo, and King’s College Hospital; Iain C. Macdougall was the most prolific author, while Masaomi Nangaku demonstrated the highest citation impact and centrality. Keyword analysis revealed a growing focus on clinical trials and pathophysiology, highlighting three core therapeutic strategies: erythropoiesis-stimulating agents, iron supplementation, and hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs), along with several emerging research topics targeting sodium-glucose cotransporter 2 (SGLT2), hepcidin, fibroblast growth factor 23 (FGF23), gut microbiota, zinc, and stem cells. Our conclusions indicate that the field has evolved from erythropoietin replacement therapy to HIF-PHI-centered physiological modulation. Current hotspots center on HIF-PHI clinical translation, with potential therapeutic avenues including SGLT2 inhibitors, hepcidin antagonists, FGF23 signaling modulation, gut microbiota regulation, zinc supplementation, and stem cell-based therapeutics.

Background Patients with maintenance hemodialysis (MHD) present endothelial dysfunction (ED), which is characterized by impaired vasodilation and a pro-inflammatory state. Lipoprotein(a) (Lp(a)) has pro-inflammatory and pro-atherogenic properties. No study has investigated the association between serum Lp(a) and ED in patients with MHD. This study was conducted to address this issue. Methods We collected serum specimens from 123 fasting MHD patients. The endothelial function was measured using the vascular reactivity index (VRI) determined by digital thermal monitoring, and VRI values of ≥ 2.0, 1.0 to <2.0, and < 1.0, indicated good, intermediate, and poor vascular reactivity, respectively. Lp(a) levels were measured by enzyme-linked immunosorbent assay. Results Of the 123 MHD patients, 54 (43.9%) had good VRI, 51 (41.5%) had intermediate VRI, and 18 (14.6%) had poor VRI. Serum Lp(a) levels (p < 0.001) were significantly higher in the poor and intermediate VRI groups than in the good VRI group. The log-transformed serum Lp(a) (log-Lp(a); p < 0.001) showed a negative correlation with VRI values. Multivariate logistic regression analyses indicated that serum Lp(a) level was independently associated with vascular reactivity dysfunction (both intermediate and poor VRI; p = 0.001) and poor vascular reactivity (poor VRI; p < 0.001). The areas under the receiver operating characteristic curve were 0.754 and 0.853 for predicting vascular reactivity dysfunction and poor vascular reactivity, respectively, by Lp(a). Conclusion The serum Lp(a) level had a negative correlation with the VRI, and it may serve as a potential biomarker for early detection of ED in MHD patients.

Objective The study aims to summarize the most recent evidence on the cost-effectiveness of chronic kidney disease (CKD) screening, identify the most cost-effective strategies under various conditions, and compare methodologies used in current health economics evaluations. The findings provide insights to support the implementation of appropriate screening strategies, particularly in low- and middle-income countries. Methods The final search was conducted between January 1, 2010, and July 1, 2024. Studies were screened for inclusion, and data were extracted, recalculated, and subjected to quality assessment. Results Of the 786 articles identified, 24 studies met the inclusion criteria. The probability of screening being cost-effective was 100% for diabetic populations, 75% for those with hypertension, and 72% for the general population. Key drivers of the cost-effectiveness models included drug efficacy, discount rates, and CKD progression probabilities. For diabetic populations, initiating at around age 50 with intervals of 5 to 10 years was generally found to be appropriate. The overall quality of the included studies was high. Conclusions CKD screening is cost-effective in high-risk groups such as those with diabetes or hypertension, while general population screening depends on prevalence, methods, and frequency. In resource-limited settings, phased implementation starting with high-risk groups, integration into existing care pathways, and pilot programs using digital tools may enhance feasibility. Future research should refine optimal methods, timing, and intervals, and compare multiple strategies rather than only against standard care.

Background Renal injury is a severe complication among individuals diagnosed with gout. This research constructed a machine learning predictive model to assess renal injury risk in gout patients. Methods In this study, we trained predictive models for renal injury in patients with gout using NHANES, from 2007 to 2018 database. Extreme Gradient Boosting (XGBoost), support vector machine (SVM) and K-Nearest Neighbors (KNN) were used to train models. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), along with calibration curves and standard evaluation metrics including sensitivity, specificity, accuracy, and F1 score. Results A cohort of 1,203 patients was analyzed using seventeen variables to develop the predictive model. Extreme Gradient Boosting (XGBoost) was found to be the most effective model due to the area under the receiver operating characteristic curve (AUC). Extreme Gradient Boosting (XGBoost) was explained using variable importance. The four most important variables are blood urea nitrogen, age, uric acid, and urinary albumin. Conclusions This research successfully developed machine learning (ML) models to predict renal impairment in gout patients, with the XGBoost model demonstrating superior performance among the three models tested. And we constructed a Web-based tool for calculating the probability of kidney injury in gout patients based on the model XGBoost. We developed a web-based tool that leverages the XGBoost model to estimate the likelihood of renal injury in patients with gout.

Background Septic associated acute kidney injury (SA-AKI) is common in the critically ill. Inadequate renal medullary tissue oxygenation has been linked to its pathogenesis. The aim of this preliminary study was to assess the feasibility of intermittent PuO2 monitoring using a blood gas analyzer in sepsis patients; to explore the effectiveness of time-weighted average PuO2 (PuO2TW) for predicting SA-AKI. Methods A total of 76 consecutive adult patients who were admitted to our intensive care unit (ICU) from September 2023 to March 2024 were prospectively recruited. PuO2 was measured with a blood gas analyzer at 0h, 3h, and 6h after ICU admission. PuO2TW was determined by the sum of the mean PuO2 values among consecutive time points multiplied by the period of time between consecutive time points and then dividing by the total time. All patients were followed throughout the ICU stay, and the development of SA-AKI during 48 h was evaluated. Results Approximately 23.68% developed AKI during the ICU stay. PuO2TW was lower in patients who developed AKI. The ROC curve analysis revealed that lower PuO2TW was associated with AKI development at the cutoff of <68 mmHg (area under the curve [AUC] 0.687; p = .008). In the logistic regression models, PuO2TW lower than 68 mmHg was associated with the development of AKI, when adjusted by confounding factors (OR 8.20; p = .002). Conclusions Measurement of PuO2 is feasible by collecting urine from a Foley catheter for analysis in a blood gas machine. 6h PuO2TW had a significant independent predictive value for AKI.

Frailty is widely recognized to be associated with kidney function decline, but its longitudinal relationship with rapid estimated glomerular filtration rate (eGFR) decline remains unclear. This study examined associations between frailty measures and rapid eGFR decline using both frailty phenotype (FP) and frailty index (FI) in two large cohorts. We analyzed baseline frailty data from the China Health and Retirement Longitudinal Study (CHARLS) and Health and Retirement Study (HRS), with longitudinal trajectory analysis in HRS participants. Rapid eGFR decline was defined as annual decrease ≥4 mL/min/1.73 m2/year. Multiple imputation with inverse probability weighting addressed missing data and selection bias. Using FP criteria, frailty was significantly associated with higher odds of rapid eGFR decline compared to non-frail individuals (CHARLS: OR 1.93, 95% CI 1.13–3.29; HRS: OR 1.48, 95% CI 1.10–1.99). Longitudinally, progression from non-frail to pre-frail/frail status was associated with 27% higher odds, while improvement from pre-frail status was associated with 35% lower odds. Frailty improvement in baseline-frail individuals showed no significant effect. Each 1-point annual increase in FP score was associated with 91% higher odds (OR 1.91, 95% CI 1.46–2.51). FI assessment yielded consistent results with optimal population-specific thresholds (FI ≥ 0.25 for CHARLS, FI ≥ 0.32 for HRS). Reverse association analysis revealed bidirectional relationships, more pronounced among participants with baseline eGFR <60 mL/min/1.73 m2. Both baseline frailty and frailty progression are independently associated with rapid eGFR decline, supporting the potential value of frailty assessment in identifying patients at risk for kidney function decline.