Background: Apolipoprotein L1 ( APOL1 )-mediated kidney disease (AMKD) is an aggressive form of chronic kidney disease (CKD). This study described characteristics of non-diabetic patients with AMKD and compared their disease progression to non-diabetic patients with other forms of CKD. Methods: This retrospective study used clinical and biosample data from NashBio (Nashbio contains electronic health records (EHR) generated during clinical encounters at Vanderbilt University Medical Center (VUMC)). Non-diabetic patients with ≥ 1 CKD diagnosis code who were ≥10 years of age at index (date of first CKD diagnosis code in patient’s medical record) were included. The AMKD and other forms of CKD cohorts were defined based on the presence of APOL1 risk alleles and then their clinical and demographic characteristics were described. To assess progression patients were matched 1:1 on gender, presence of hypertension, and CKD stage at index and were followed until the last observation in the data. Progression outcomes including time from index to dialysis, kidney transplant, and diagnosis of CKD requiring kidney replacement therapy were assessed using Kaplan-Meier analysis, with log-rank tests used to compare matched cohorts. Results: The study included 645 patients with AMKD and 6,749 patients with other forms of CKD. AMKD patients were significantly younger than other CKD patients (median 44.0 vs. 61.0 years; p<0.001) and had significantly less comorbidity burden such as cardiovascular diseases (16.9% versus 36.6% p < 0.001). Additionally, AMKD patients had higher rates of CKD requiring kidney replacement therapy at index (59% vs. 24%, p<0.001). After 1:1 matching, AMKD patients reached dialysis and kidney transplant significantly faster than other CKD patients (both p<0.001). Among patients who did not require kidney replacement therapy at index (n=264 per cohort), AMKD patients progressed to CKD requiring kidney replacement therapy significantly faster than other CKD patients (p<0.01). Conclusions: Non-diabetic patients with AMKD experienced more rapid disease progression than patients with other forms of CKD, despite being younger and having lower comorbidity burden.

Peritoneal dialysis (PD) associated peritonitis is a common complication and main cause of PD failure among end-stage chronic kidney disease (CKD) patients, presenting with abdominal pain, diarrhea and cloudy dialysate. On the other side, these patients may have an increased risk for Clostridioides difficile infection (CDI), with a clinical presentation indistinguishable from PD associated peritonitis. We present the case of a female patient who presented with multiple episodes of watery diarrhea days after PD catheter insertion, treated initially as a suspected PD associated peritonitis but later identifying C. difficile toxin assay in stool and responding with triple therapy including oral vancomycin, metronidazole and tigecycline. Considering the scarce evidence, we conducted a literature search and identified 10 case reports involving 11 patients describing CDI associated peritonitis in patients with PD. Most cases initiated empiric intraperitoneal treatment for PD associated peritonitis but after lack of clinical improvement or increase in PD fluid cell count, and a positive C. difficile toxin assay in stool, treatment for CDI was started. Half of these patients had received prior antibiotic therapy or had a prior hospital admission. In conclusion, patients with PD associated peritonitis unresponsive to initial empiric intraperitoneal treatment should be tested for C. difficile in stool, especially those with previous antibiotic exposure or hospital admission.

The human gut is host to a diversity of microorganisms, including a parasite called Blastocystis. While there are increasing reports characterizing Blastocystis subtypes (STs) among healthy individuals, only a few studies have investigated the Blastocystis STs in renal or dialysis patients. This study investigates the Blastocystis prevalence and STs in hemodialysis patients. Fifty healthy controls and 100 chronic kidney disease patients undergoing dialysis participated in the study. Blastocystis infection was identified by using microscopic and molecular diagnosis using 18S rRNA-PCR. Then all positive samples were sent for sequencing to identify which ST they belong to. Phylogenetic and pairwise distance analyses were performed to confirm the validity of the STs. Thirty-four hemodialysis patients were infected with Blastocystis while 17 patients in the control were infected with the parasite. All positive samples were then confirmed using PCR. Genetic sequencing analysis subsequently revealed that 66% of Blastocystis infection belonged to ST1 and ST3 (33% each), followed by ST10 (20%), and ST6 (14%). The nucleotide sequence analysis of the 385 bp 18S rRNA gene revealed a >97% identity with previously identified Blastocystis isolates. The genetic analysis showed that the 8 identified isolates correspond to previously observed alleles. Six ST1 isolates produced a high frequency of Blastocystis isolates matching allele 4, with very low genetic divergence. ST3 isolates showed relatively increased genetic diversity and matching allele 34, which is the most common allele worldwide.

Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver cancer. Its association with chronic kidney disease (CKD) and end-stage renal disease (ESRD) is unclear. Using Taiwan's National Health Insurance Research Database (NHIRD), we analyzed the relationship between iCCA and CKD/ESRD. Molecular alterations were explored through whole-exome sequencing (WES) and Archer FusionPlex in 24 surgical specimens from 22 CKD/ESRD patients. Aristolochic acid (AA)-related DNA adducts were quantified using liquid chromatography/mass spectrometry. NHIRD showed iCCA incidence was 15.35, 26.77, and 34.14 per 100,000 person-years in the general population, CKD, and ESRD patients, respectively. ESRD patients under 65years had the highest iCCA incidence rate ratio (7.37, P < 0.0001). CKD/ESRD was an independent risk factor (adjusted OR 1.57, P < 0.0001). WES revealed recurrent TP53 (33%), LRP1B (21%), BAP1 (21%) mutations, CDKN2A/B deletion (25%), and FGFR3::TACC3 or SLMAP::ROS1 fusions in single cases. COSMIC SBS22a-associated mutations occurred in 15 cases (68%), more frequent in ESRD-associated tumors (P = 0.05). AA-related DNA adducts were detected in 9 cases (41%), predominantly in ESRD patients (89%). The correlation between SBS22a mutations and dA-AL-I burdens was weak, and canonical T>A transversions were rare in driver mutations. In conclusion, a subset of CKD-/ESRD-associated iCCAs in Taiwan shows molecular and chemical evidence of AA exposure. However, the modest correlation between AA adducts and SBS22a signatures and the paucity of T>A transversions in driver genes suggests that AA acts as a contributory rather than causal factor, possibly synergizing with aging and liver disease-related mutagenic processes.

Background and purpose Exercise improves various health outcomes in patients with chronic kidney disease, but the impact of different types of exercise on chronic kidney disease patients undergoing dialysis is not well understood. This aimed to comparatively assess the impact of intradialytic resistance and aerobic exercises on urea reduction rate concentration and various quality of life dimensions in chronic kidney disease patients. Materials and Methods In this single-blinded, randomized controlled trial with a pre-and post-test design, 30 patients (both sexes, aged 25-35 years, BMI 18-25 kg/m²) diagnosed with stage 4 chronic kidney disease and stable on dialysis for a minimum of 2 months were enrolled. Patients were randomly assigned equally to either the resistance exercise group or the aerobic exercise group and underwent respective exercise interventions for 8 weeks. Urea reduction rate and quality of life dimensions were evaluated before and after the intervention period. Results Both resistance and aerobic exercise modalities significantly changed urea reduction rate and quality of life dimensions in chronic kidney disease patients (p&lt;0.05). No significant difference in post-intervention urea reduction rate levels (mg/dL) was observed between the groups (resistance group = 89.43 ± 14.29; aerobic group = 86.33 ± 14.75; p=0.563). Furthermore, all quality of life dimensions exhibited significant differences between the groups, except for physical function. The aerobic group exhibited superior general health outcomes compared to the resistance exercise group (mean = 59.98 ± 0.96 versus 56.26 ± 0.95) following the intervention. Conclusion Aerobic exercise showed better general health outcomes, though both modalities improved Urea reduction rate and quality of life. Integrating intradialytic exercise enhances patient wellbeing.

Arteriovenous Fistula (AVF) failure remains a significant challenge in patients on hemodialysis. No meta-analysis has concluded the relationship between fetuin-A serum levels, arterial calcification, and AVF failure. This study aims to evaluate the relationship between fetuin-A levels and AVF failure through vascular calcification in CKD patients undergoing hemodialysis. This meta-analysis was conducted according to the PRISMA guideline. On October 1st, 2024, a literature search was conducted in PubMed and ScienceDirect. Data were analyzed using Review Manager for pooled hazard ratio and standardized mean difference (SMD), while MedCalc software was used to calculate the pooled correlation coefficient. A total of 26 observational studies were included. Meta-analysis showed that fetuin-A levels were negatively correlated with vascular calcification (r = -0.530; 95% CI: -0.781 to -0.132; p = 0.011). The mean fetuin-A levels were lower in the group with vascular calcification than those without calcification (SMD = -1.71; 95% CI: -2.58 to -0.85; p = 0.0001). Patients with vascular calcification had a 2.98 times higher risk of AVF failure (OR = 2.98; 95% CI: 1.78-4.99; p < 0.0001). Three studies showed that high fetuin-A levels were a protective factor against AVF failure (HR = 0.76; 95% CI: 0.63-0.91; p = 0.003). Low fetuin-A levels were associated with increased vascular calcification and risk of AVF failure in CKD patients undergoing hemodialysis. These findings suggest the potential of fetuin-A as a predictive biomarker and therapeutic target in reducing AVF failure. Further studies with standard testing methods are recommended to confirm this association.

The progression of chronic kidney disease (CKD) is closely associated with damage to the endothelial glycocalyx (eGC) of the renal microvasculature. The eGC, particularly its heparan sulfate (HS) components, is crucial for maintaining the charge-selective barrier and microenvironmental homeostasis. Modern pharmacological investigations of marine brown algae (e.g., Saccharina japonica ), traditionally used in medicine for conditions such as “edema,” reveal that their principal active component, fucoidan, is a sulfated polysaccharide with marked physicochemical similarities to endogenous HS. This review systematically posits that the core mechanism underlying the nephroprotective effects of fucoidan, as a natural product, lies in its direct targeting and repair of the damaged eGC. Through a systematic literature search up to November 2025, this review elucidates that fucoidan, especially its low-molecular-weight fractions, can consolidate and reconstitute the glycocalyx structure via dynamic integration, competitive substitution, and activation of intracellular signaling pathways. This central action not only directly restores the renal charge barrier and reduces proteinuria but also, by stabilizing endothelial function, systemically inhibits the inflammation and fibrosis cascades triggered by glycocalyx injury. The efficacy of fucoidan in diverse preclinical models, coupled with clinical trial evidence for fucoidan-based drugs in human CKD patients, collectively supports the validity of a glycocalyx-targeted therapeutic strategy. We conclude that fucoidan represents a natural product derived from traditional wisdom, with a defined molecular mechanism and translational potential, offering a promising complementary strategy for the comprehensive management of CKD.

Background Psychological disorders such as anxiety and depression are common but often underrecognized among patients with chronic kidney disease (CKD), posing challenges for inpatient nursing care. This study aimed to identify key risk factors and develop predictive models to assist clinical nurses in early psychological risk identification and intervention planning. Methods This retrospective cross-sectional study for model development included 1,420 adult inpatients with CKD stages 1–5 admitted to a tertiary hospital in Southwest China from March 2023 to March 2025. Anxiety and depression were assessed using the Generalized Anxiety Disorder 7-item scale (GAD-7) and Patient Health Questionnaire 9-item scale (PHQ-9) within 48 hours of admission. Nursing-relevant demographic, clinical, and psychosocial data were extracted from electronic health records. Multivariate logistic regression was used to identify predictors. Two nomograms were developed, and model performance was assessed via ROC curves, calibration plots, and 1,000 bootstrap validations. Results Screening-positive anxiety and depressive symptoms (GAD-7/PHQ-9 ≥5) were observed in 33.2% and 35.8% of patients, respectively. Significant predictors of anxiety included younger age, female sex, low income, frequent hospitalizations, hypoalbuminemia, sleep disturbance, diabetes, and absence of family accompaniment. Similar predictors were found for depression, along with low education and dialysis status. Both models demonstrated strong discrimination (AUC = 0.830 for anxiety; 0.829 for depression) and good calibration. The nomograms allow bedside nurses to estimate psychological risk using routinely available data. Conclusions Anxiety and depression are highly prevalent among hospitalized CKD patients in Southwest China and are associated with modifiable psychosocial and clinical factors. The validated nursing-oriented prediction models offer practical tools to support early risk stratification and targeted psychological care planning in nephrology nursing practice.

Chronic kidney disease (CKD) is a global health problem with an increasing prevalence and is estimated to be the fifth leading cause of death by 2040. The main cause of mortality in CKD is cardiovascular complications, particularly atherosclerosis. Damage to glomerular filtration causes urinary albumin, while High Density Lipoprotein (HDL) dysfunction disrupts the reverse transport of cholesterol and the antioxidant, anti-inflammatory, and vasoprotective properties of HDL. In CKD, changes in the quantity and quality of HDL and increased urinary albumin reflect vascular and renal damage. The research aims to determine the relationship between serum HDL levels and urinary albumin levels in patients with chronic kidney disease at the ODSK Provincial Hospital in North Sulawesi. Methods: The study design used was an observational analytical study with a cross-sectional approach. This study used primary data in the form of blood and urine samples from hemodialysis patients in November 2025. The study employed simple random sampling with a sample size of 30 patients who met the inclusion and exclusion criteria. Based on the results of Pearson's correlation test, a p-value of 0.237 (&gt; 0.05) was obtained. There is no significant relationship between serum HDL levels and urinary albumin levels in chronic kidney disease at ODSK Provincial Hospital in North Sulawesi.

Background There is minimal literature on the spectrum and long-term outcomes of acute kidney injury (AKI) from tropical countries. Methods Patients with AKI without underlying chronic kidney disease (CKD), were recruited from March 2017 to December 2018 to assess their outcomes. Survivors were followed for a year post-discharge. A linear model with fixed effects was created to compare the estimated glomerular filtration rate (eGFR) trajectories of patients with and without CKD at the end of follow-up. Results A total of 529 patients with AKI were recruited, of which 288 (54.4%) were hospital-acquired AKI. Infections and sepsis were the most common aetiologies for community-acquired AKI and hospital-acquired AKI. The overall mortality rate was 42.9% (n=227). The ICU stay (HR 1.78; 95% CI 1.08–2.93), mechanical ventilation (HR 1.98; 95% CI 1.09–3.54), and the requirement for inotropic support (HR 2.36; 95% CI 1.65–3.39) were independent risk factors of in-hospital mortality. Among 156 subjects with long-term follow-up, 70 (44.9%) developed CKD after a median follow-up of 12 months. Age (p&lt;0.001) and hospital-acquired AKI (p=0.014) were significant predictors, whereas ICU stay and comorbid conditions did not influence the GFR trajectories. CKD patients showed a lower eGFR from the first follow-up (p&lt;0.001). Conclusions AKI is associated with significant mortality. Even after an apparent recovery, around half the survivors progress to CKD at the end of 1 year.

Prevalence of pulmonary hypertension and its associated factors among chronic kidney disease patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: an institution-based retrospective study.

IntroductionAcute kidney injury (AKI) and chronic kidney disease (CKD) are widely correlated. However, the risk factors associated with outcomes of AKI in CKD patients have not been widely studied to date.ObjectivesTo identify factors associated with outcomes of death and need for kidney support therapy (KST) in patients with CKD who present with AKI during hospital stay.MethodsRetrospective cohort conducted from July 2018 to June 2022 that included patients with CKD and superimposed AKI. Sociodemographic data related to CKD, AKI, and the progression of patients to outcomes as death and KST were collected. The results were discussed with a significance level of p < 0.05.ResultsA total of 327 patients were included. The patients had a mean age of 68.6 ± 11.4 years, the majority were men, and the most prevalent comorbidities were hypertension (81.7%) and cardiovascular disease (61.5%). The mean creatinine was 1.85 ± 0.74 mg/dL. The main etiology of CKD was undetermined (26.6%) and of AKI was septic (45.3%). Patients were hospitalized mainly for infectious or cardiovascular causes (22.3% each). Overall mortality was 29.1%, and the need for KST was 35.2%. In the intensive care unit (ICU), 73.2% required dialysis and 74.4% died, reaching 85.7% in those with KST. CKD staging was not associated with any of the primary outcomes. The risk factors for KST were obesity, ATN‐ISS score, and creatinine elevation greater than three times the baseline. The risk factors for death were ATN‐ISS score, undetermined CKD, septic AKI, ICU admission, and KST.ConclusionsMortality and need for KST in CKD patients admitted to the ICU and who develop AKI are high. Variables related to AKI were more relevant than those related to CKD for clinical outcomes.

The benefits of caffeine to human health have been widely reported, but the association between caffeine intake and mortality among patients with chronic kidney disease (CKD) has been rarely reported in large epidemiologic studies. This study aimed to investigate the association between caffeine intake and mortality among CKD patients. Our study was conducted among non-dialysis CKD patients in the 2003-2016 National Health and Nutrition Examination Survey (NHANES). Weighted COX regression analysis was used to explore the linear relationship between caffeine intake and mortality among CKD patients (including all-cause mortality, as well as mortality due to cardiovascular disease, cancer, cerebrovascular disease, nephropathy, and influenza or pneumonia). Restricted cubic spline analysis was performed to explore the nonlinear relationship. Finally, threshold effects were analyzed through fitting a two-piecewise linear regression model. In a fully adjusted model, no significant linear association was found between caffeine intake and mortality. However, there was a U-shaped association between caffeine intake and all-cause mortality (inflection point: 277mg). Moreover, there was a J-shaped association between caffeine intake and cardiovascular mortality (inflection point: 252mg) and cancer mortality (inflection point: 79mg). All-cause mortality was reduced in CKD patients when caffeine intake was less than 277mg (about 1.85 cups of Americano). However, excessive caffeine intake was associated with increased all-cause mortality, cardiovascular mortality and cancer mortalityin this population.

Anemia is a prevalent complication in chronic kidney disease (CKD) that remains challenging to manage effectively. Daprodustat was recently approved for anemia in CKD. This meta-analysis aims to provide evidence-based insights for the clinical use of daprodustat in CKD-related anemia. A systematic review and meta-analysis were conducted in accordance with the PRISMA 2020 guidelines, with searches conducted in databases such as PubMed and ClinicalTrials.gov, encompassing studies published up to August 30, 2024. Data from 12 randomized controlled trials involving 9,278 CKD patients (both dialysis-dependent (DD) and non-dialysis-dependent (NDD)) were analyzed. Daprodustat significantly increased hemoglobin (Hb) levels compared to placebo in both NDD (MD = 1.92, 95% CI [0.67, 3.02], p = 0.001) and DD (MD = 1.72, 95% CI [0.34, 3.65], p = 0.01) patients. However, no significant difference in Hb levels was observed between daprodustat and recombinant human erythropoietin (rhEPO) (MD = 0.05, 95% CI [-0.10, 0.21], p = 0.50). Daprodustat improved iron metabolism by significantly lowering hepcidin and increasing total ironbinding capacity (TIBC) compared to rhEPO. Cardiovascular safety analysis showed no significant difference in major adverse cardiovascular events (MACE) between daprodustat and rhEPO (RR = 1.02, 95% CI [0.92, 1.14], p = 0.83), though a significant reduction in MACE incidence was observed in DD patients (RR = 0.98, 95% CI [0.87, 1.15], p = 0.02). Serious adverse events were significantly lower with daprodustat compared to rhEPO (RR = 0.82, 95% CI [0.66, 0.84], p = 0.02 in DD; RR = 0.61, 95% CI [0.48, 0.78], p = 0.008 in NDD patients). Daprodustat offers a promising alternative to traditional anemia treatments in CKD, with efficacy comparable to rhEPO and a favorable cardiovascular safety profile, which marks its potential as a valuable therapeutic option.

Prognostic impact of chronic kidney disease in patients with atrial fibrillation after percutaneous coronary intervention.

Background Chronic kidney disease (CKD) has a significant impact on psychological well-being. Here, the psychological evaluation of patients with CKD undergoing replacement treatment (dialysis or kidney transplantation) and conservative therapy (preemptive patients, who are waiting list for kidney transplantation) was analyzed. In addition, serum irisin levels, a protein displaying anxiolytic and antidepressant effects in mice, were measured in dialysis patients. Methods Dialysis ( N = 57), non-dialysis (preemptive, N = 31) and kidney transplant patients ( N = 33) were enrolled. All participants underwent psychometric tests including State–Trait Anxiety Inventory (STAI-Y 1 and 2 form), Psychological General Well-Being Index (PGWBI), Symptom Checklist-90-R (SCL-90-R), etc. Serum irisin levels in dialyzed patients were measured by ELISA assay. Results Dialysis patient group scored worse on all tests performed than both preemptive and kidney transplant patients. Indeed, dialysis patients displayed the lowest PGWBI score, and higher scores of BDI, and STAY-1 and STAY-2, compared with preemptive and kidney transplant patients. We also found that about 40% of dialysis patients showed significant psychological distress with higher clinical attention values in the somatization, obsessive-compulsive, depression, and anxiety domains assessed by SCL-90. Furthermore, the stratification of all patients into groups younger and older than 50 years showed that the older group of transplanted patients displayed better outcomes than the younger ones. Finally, stratification of dialysis patients according to irisin levels revealed that only those with higher serum irisin levels had better psychological conditions in tests. Conclusions Kidney transplantation as well as conservative therapy were related to a lower prevalence of depressive symptoms and other psychological disorders than dialysis. Furthermore, all transplanted patients over 50 years of age showed better outcomes than the younger ones. However, dialyzed patients with high levels of circulating irisin displayed better psychological conditions. Overall, our findings supported the importance to provide timely access to transplantation and to improve psychological support for dialysis patients.

Background. Chronic kidney disease (CKD) remains a significant global health issue because it often leads to long-term complications that affect patients’ physiological and functional status. One factor that may influence disease progression and symptom burden is the imbalance of calcium and phosphate levels. Objective. This study aims to evaluate the association between calcium–phosphate levels, the severity of pruritus, and the quality of life in CKD patients receiving hemodialysis at Prof. dr. Chairuddin P. Lubis Hospital, Universitas Sumatera Utara, Medan. Methods. A correlational analytic design was employed using the Slovin formula, resulting in 63 respondents selected through a cross-sectional approach. Data were obtained from laboratory findings, medical records, and standardized questionnaires collected between August and October 2025. Results. Most respondents were in the 46–65-year age group (54%), with women representing 55.6% of the sample. A total of 58.7% were unemployed, 31.7% identified as Batak, and 58.7% had completed senior high school. Nearly half of the patients had undergone hemodialysis for more than 36 months (45%), and 62.5% presented with normal calcium–phosphate levels. Moderate pruritus, assessed using the 5D Itch Scale, was the most common category (56.3%), while the KDQOL-36 indicated that 45.3% of patients had a moderate quality of life. Statistical testing revealed a significant association between calcium–phosphate levels and pruritus severity (p = 0.044), as well as quality of life (p = 0.011). Conclusion. Calcium–phosphate balance is significantly related to both pruritus severity and quality of life in CKD patients undergoing hemodialysis at RS CPL USU.

Chronic kidney disease (CKD) is associated with chronic inflammation and metabolic dysregulation. While endothelin-1 (ET-1) has been extensively studied, the role of endothelin-2 (ET-2) in CKD remains poorly understood. This cross-sectional study included 76 participants, 12 healthy controls and 64 CKD patients, stratified into three groups based on estimated glomerular filtration rate (eGFR): Group 1 (eGFR ≥ 90 mL/min/1.73 m2), Group 2 (eGFR 45-89 mL/min/1.73 m2), and Group 3 (eGFR 15-44 mL/min/1.73 m2). Serum concentrations of ET-1, ET-2, ET-3, uric acid (UA), and inflammatory markers (hsCRP and IL-6) were measured. ET-2 levels were significantly higher in the advanced CKD group (median 24.49 pg/mL) compared to controls (median 19.32 pg/mL; p = 0.030). No significant differences were observed for ET-1 or ET-3 across groups. ET-2 levels positively correlated with UA (rho = 0.243, p = 0.036), hsCRP (rho = 0.241, p = 0.039), and IL-6 (rho = 0.244, p = 0.038). These findings suggest that ET-2 may represent a potential biomarker reflecting metabolic and inflammatory dysregulation in CKD and highlight its possible relevance in disease severity assessment.

Long-term exposure to ambient air pollutants is increasingly recognized as detrimental to kidney health, yet its association with incident chronic kidney disease (CKD) among people diagnosed with hypertension remains poorly elucidated. To investigate the link between exposure to multiple ambient air pollutants [NO2, O3, particulate matter (PM)1, PM2.5, PM10] and CKD among middle-aged and older adults with hypertension, while simultaneously assessing whether lipid biomarkers mediate this association. The study population was drawn from the China Health and Retirement Longitudinal Study and comprised 3,041 participants with hypertension aged ≥ 45years, all of whom were CKD-free at baseline in 2011. Participants were followed up until they were diagnosed with CKD or the year 2020. The effects of ambient air pollutants were examined using continuous-time Cox proportional hazards models, with models adjusted for relevant confounders encompassing demographic characteristics, lifestyle factors, and comorbidities. Mediation analyses were carried out for the evaluation of lipid biomarkers as potential mediators. Throughout the follow-up, CKD was documented in 334 participants, with an overall incidence of 10.98%. In fully adjusted Cox proportional hazards models, significant associations were found between exposures to PM1, PM2.5, and PM10 and the risk of developing CKD, and these associations demonstrated robust dose-response trends across quartiles. Findings from mediation analyses indicated that the non-high-density lipoprotein (NHDL) to HDL ratio (NHHR) acted as a partial mediator for the association between PM2.5 exposure and CKD risk, and NHDL did so for the association between PM10 exposure and CKD risk. In middle-aged and older adults with hypertension, long-term PM exposure is associated with elevated CKD risk, and this association is partially mediated by lipid metabolism dysregulation, specifically involving NHDL and NHHR.

Unravelling impact of comorbidities on mortality risks in CKD patients during the COVID-19 pandemic: An explainable AI-driven study.