Management Of Kidney Disease Research Articles

Earlier Intervention in Diabetic Kidney Disease Management Using the In Vitro Diagnostic Test PromarkerD Shows Economic Health Benefits over Current Standard of Care

Earlier Intervention in Diabetic Kidney Disease Management Using the In Vitro Diagnostic Test PromarkerD Shows Economic Health Benefits over Current Standard of Care

A Jordanian Multidisciplinary Consensus Statement on Chronic Kidney Disease Screening, Diagnosis, and Management

A Jordanian Multidisciplinary Consensus Statement on Chronic Kidney Disease Screening, Diagnosis, and Management

Ellagic acid ameliorates renal fibrogenesis by blocking epithelial-to-mesenchymal transition.

Ellagic acid (EA), a kind of polyphenol found in numerous fruits and vegetables, has anti-inflammatory, anti-apoptotic, anti-oxidant, and anti-fibrotic effects against a variety of diseases, but its role in mediating renal fibrogenesis remains unknown. We used an in vivo mouse unilateral ureteral obstruction (UUO) model and an in vitro model with HK-2 cell lines treated with EA and transforming growth factor β1 (TGF-β1). The expression of epithelial-to-mesenchymal transition (EMT)-related proteins of UUO mice was examined using immunohistochemical staining. Liver function and renal function were evaluated using biochemical testing. Western blot analysis was used to determine the proteins related to EMT, and MTT assay was used to determine cell viability. In UUO mice fed EA, both microscopical examination with immunohistochemical staining and western blotting protein analysis showed reduced expression of fibrotic (α-SMA, fibronectin, and collagen I)- and EMT (vimentin and N-cadherin)-related proteins, compared with sham control. In HK-2 cells treated with TGF-β1, EA decreased motility as well as expression of α-SMA, collagen-I, fibronectin, N-cadherin, and vimentin. EA reduced the progression of the morphological transformations and concomitantly suppressed the expression of fibrotic- and EMT-related proteins in vitro and in vivo. These findings improved our understanding of the role of EA in suppressing renal fibrogenesis and demonstrated the promising role EA may play in the management of chronic kidney disease.

Identifying key genes for diabetic kidney disease by bioinformatics analysis

BackgroundThere are no reliable molecular targets for early diagnosis and effective treatment in the clinical management of diabetic kidney disease (DKD). To identify novel gene factors underlying the progression of DKD.MethodsThe public transcriptomic datasets of the alloxan-induced DKD model and the streptozotocin-induced DKD model were retrieved to perform an integrative bioinformatic analysis of differentially expressed genes (DEGs) shared by two experimental animal models. The dominant biological processes and pathways associated with DEGs were identified through enrichment analysis. The expression changes of the key DEGs were validated in the classic db/db DKD mouse model.ResultsThe downregulated and upregulated genes in DKD models were uncovered from GSE139317 and GSE131221 microarray datasets. Enrichment analysis revealed that metabolic process, extracellular exosomes, and hydrolase activity are shared biological processes and molecular activity is altered in the DEGs. Importantly, Hmgcs2, angptl4, and Slco1a1 displayed a consistent expression pattern across the two DKD models. In the classic db/db DKD mice, Hmgcs2 and angptl4 were also found to be upregulated while Slco1a1 was downregulated in comparison to the control animals.ConclusionsIn summary, we identified the common biological processes and molecular activity being altered in two DKD experimental models, as well as the novel gene factors (Hmgcs2, Angptl4, and Slco1a1) which may be implicated in DKD. Future works are warranted to decipher the biological role of these genes in the pathogenesis of DKD.

Risk Factors for Sudden Cardiac Arrest Among Hispanic or Latino Adults in Southern California: Ventura PRESTO and HCHS/SOL.

Background Out-of-hospital sudden cardiac arrest (SCA) is a leading cause of mortality, making prevention of SCA a public health priority. No studies have evaluated predictors of SCA risk among Hispanic or Latino individuals in the United States. Methods and Results In this case-control study, adult SCA cases ages 18-85 (n=1,468) were ascertained in the ongoing Ventura Prediction of Sudden Death in Multi-Ethnic Communities (PRESTO) study (2015-2021) in Ventura County, California. Control subjects were selected from 3033 Hispanic or Latino participants who completed Visit 2 examinations (2014-2017) at the San Diego site of the HCHS/SOL (Hispanic Community Health Survey/Study of Latinos). We used logistic regression to evaluate the association of clinical factors with SCA. Among Hispanic or Latino SCA cases (n=295) and frequency-matched HCHS/SOL controls (n=590) (70.2% men with mean age 63.4 and 61.2 years, respectively), the following clinical variables were associated with SCA in models adjusted for age, sex, and other clinical variables: chronic kidney disease (odds ratio [OR], 7.3 [95% CI, 3.8-14.3]), heavy drinking (OR, 4.5 [95% CI, 2.3-9.0]), stroke (OR, 3.1 [95% CI, 1.2-8.0]), atrial fibrillation (OR, 3.7 [95% CI, 1.7-7.9]), coronary artery disease (OR, 2.9 [95% CI, 1.5-5.9]), heart failure (OR, 2.5 [95% CI, 1.2-5.1]), and diabetes (OR, 1.5 [95% CI, 1.0-2.3]). Conclusions In this first population-based study, to our knowledge, of SCA risk predictors among Hispanic or Latino adults, chronic kidney disease was the strongest risk factor for SCA, and established cardiovascular disease was also important. Early identification and management of chronic kidney disease may reduce SCA risk among Hispanic or Latino individuals, in addition to prevention and treatment of cardiovascular disease.

Opportunities for clinical decision support targeting medication safety in remote primary care management of chronic kidney disease: A qualitative study in Northern Australia.

This study aimed to identify opportunities for clinical decision support targeting medication safety in remote primary care, by investigating the relationship between clinical workflows, health system priorities, cognitive tasks, and reasoning processes in the context of medicines used in people with chronic kidney disease (CKD). This qualitative study involved one-on-one, semistructured interviews. The participants were healthcare professionals employed in a clinical or managerial capacity with clinical work experience in a remote health setting for at least 1 year. Twenty-five clinicians were interviewed. Of these, four were rural medical practitioners, nine were remote area nurses, eight were Aboriginal health practitioners, and four were pharmacists. Four major themes were identified from the interviews: (1) the need for a clinical decision support system to support a sustainable remote health workforce, as clinicians were "constantly stretched" and problems may "fall through the cracks"; (2) reliance on digital health technologies, as medical staff are often not physically available and clinicians-on-duty usually "flick an email and give a call so that I can actually talk it through to our GP"; (3) knowledge gaps, as "it takes a lot of mental space" to know each patient's renal function and their medication history, and clinicians believe "mistakes can be made"; and (4) multiple risk factors impacting CKD management, including clinical, social and behavioural determinants. The high prevalence of CKD and reliance on digital health systems in remote primary health settings can make a clinical decision support system valuable for supporting clinicians who may not have extensive experience in managing medicines for people with CKD.

Novel Therapeutic Approaches in the Management of Chronic Kidney Disease.

Chronic kidney disease (CKD) is a progressive and incurable disease that impairs kidney function. Its prevalence is estimated to affect up to 800 million individuals within the general population, and patients with diabetes and hypertension are particularly at risk. This disorder disrupts the physiological mechanisms of the body, including water and electrolyte balance, blood pressure regulation, the excretion of toxins, and vitamin D metabolism. Consequently, patients are exposed to risks such as hyperkalemia, hyperphosphatemia, metabolic acidosis, and blood pressure abnormalities. These risks can be reduced by implementing appropriate diagnostic methods, followed by non-pharmacological (such as physical activity, dietary, and lifestyle adjustment) and pharmacological strategies after diagnosis. Selecting the appropriate diet and suitable pharmacological treatment is imperative in maintaining kidney function as long as possible. Drugs such as finerenone, canakinumab, and pentoxifylline hold promise for improved outcomes among CKD patients. When these interventions prove insufficient, renal replacement therapy becomes essential. This is particularly critical in preserving residual renal function while awaiting renal transplantation or for patients deemed ineligible for such a procedure. The aim of this study is to present the current state of knowledge and recent advances, providing novel insights into the treatment of chronic kidney disease.

Unlocking Precision Medicine for Prognosis of Chronic Kidney Disease Using Machine Learning.

Chronic kidney disease (CKD) is a significant global health challenge that requires timely detection and accurate prognosis for effective treatment and management. The application of machine learning (ML) algorithms for CKD detection and prediction holds promising potential for improving patient outcomes. By incorporating key features which contribute to CKD, these algorithms enhance our ability to identify high-risk individuals and initiate timely interventions. This research highlights the importance of leveraging machine learning techniques to augment existing medical knowledge and improve the identification and management of kidney disease. In this paper, we explore the utilization of diverse ML algorithms, including gradient boost (GB), decision tree (DT), K-nearest neighbor (KNN), random forest (RF), histogram boost (HB), and XGBoost (XGB) to detect and predict chronic kidney disease (CKD). The aim is to improve early detection and prognosis, enhancing patient outcomes and reducing the burden on healthcare systems. We evaluated the performance of the ML algorithms using key metrics like accuracy, precision, recall, and F1 score. Additionally, we conducted feature significance analysis to identify the most influential characteristics in the detection and prediction of kidney disease. The dataset used for training and evaluation contained various clinical and demographic attributes of patients, including serum creatinine level, blood pressure, and age, among others. The proficiency analysis of the ML algorithms revealed consistent predictors across all models, with serum creatinine level, blood pressure, and age emerging as particularly effective in identifying individuals at risk of kidney disease. These findings align with established medical knowledge and emphasize the pivotal role of these attributes in early detection and prognosis. In conclusion, our study demonstrates the effectiveness of diverse machine learning algorithms in detecting and predicting kidney disease. The identification of influential predictors, such as serum creatinine level, blood pressure, and age, underscores their significance in early detection and prognosis. By leveraging machine learning techniques, we can enhance the accuracy and efficiency of kidney disease diagnosis and treatment, ultimately improving patient outcomes and healthcare system effectiveness.

Chronic kidney disease in type 1 diabetes: translation of novel type 2 diabetes therapeutics to individuals with type 1 diabetes.

Current management of chronic kidney disease (CKD) in type 1 diabetes centres on glycaemic control, renin-angiotensin system inhibition and optimisation of risk factors including blood pressure, lipids and body weight. While these therapeutic approaches have significantly improved outcomes among people with type 1 diabetes and CKD, this population remains at substantial elevated risk for adverse kidney and cardiovascular events, with limited improvements over the last few decades. The significant burden of CKD and CVD in type 1 diabetes populations highlights the need to identify novel therapies with the potential for heart and kidney protection. Over the last decade, sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide 1 receptor agonists and non-steroidal mineralocorticoid receptor antagonists have emerged as potent kidney-protective and/or cardioprotective agents in type 2 diabetes. The consistent, substantial kidney and cardiovascular benefits of these agents has led to their incorporation into professional guidelines as foundational care for type 2 diabetes. Furthermore, introduction of these agents into clinical practice has been accompanied by a shift in the focus of diabetes care from a 'glucose-centric' to a 'cardiorenal risk-centric' approach. In this review, we evaluate the potential translation of novel type 2 diabetes therapeutics to individuals with type 1 diabetes with the lens of preventing the development and progression of CKD.

Unveiling the Hidden Power of Uromodulin: A Promising Potential Biomarker for Kidney Diseases.

Uromodulin, also known as Tamm-Horsfall protein, represents the predominant urinary protein in healthy individuals. Over the years, studies have revealed compelling associations between urinary and serum concentrations of uromodulin and various parameters, encompassing kidney function, graft survival, cardiovascular disease, glucose metabolism, and overall mortality. Consequently, there has been a growing interest in uromodulin as a novel and effective biomarker with potential applications in diverse clinical settings. Reduced urinary uromodulin levels have been linked to an elevated risk of acute kidney injury (AKI) following cardiac surgery. In the context of chronic kidney disease (CKD) of different etiologies, urinary uromodulin levels tend to decrease significantly and are strongly correlated with variations in estimated glomerular filtration rate. The presence of uromodulin in the serum, attributable to basolateral epithelial cell leakage in the thick ascending limb, has been observed. This serum uromodulin level is closely associated with kidney function and histological severity, suggesting its potential as a biomarker capable of reflecting disease severity across a spectrum of kidney disorders. The UMOD gene has emerged as a prominent locus linked to kidney function parameters and CKD risk within the general population. Extensive research in multiple disciplines has underscored the biological significance of the top UMOD gene variants, which have also been associated with hypertension and kidney stones, thus highlighting the diverse and significant impact of uromodulin on kidney-related conditions. UMOD gene mutations are implicated in uromodulin-associated kidney disease, while polymorphisms in the UMOD gene show a significant association with CKD. In conclusion, uromodulin holds great promise as an informative biomarker, providing valuable insights into kidney function and disease progression in various clinical scenarios. The identification of UMOD gene variants further strengthens its relevance as a potential target for better understanding kidney-related pathologies and devising novel therapeutic strategies. Future investigations into the roles of uromodulin and regulatory mechanisms are likely to yield even more profound implications for kidney disease diagnosis, risk assessment, and management.

The Bidirectional Link Between Diabetes and Kidney Disease: Mechanisms and Management.

The complex and mutually influential connection between diabetes mellitus and chronic kidney disease (CKD) is a significant focal point in the current healthcare landscape. Diabetes, a medical condition characterized by elevated blood glucose levels resulting from impaired insulin action or secretion, has become a significant global epidemic. It poses considerable challenges to healthcare systems and affects millions of individuals worldwide. Concurrently, CKD, characterized by the gradual decline of kidney function, has become a persistent health challenge. This narrative review explores the complex relationship between these two conditions, shedding light on their significant implications for public health, clinical practice, and biomedical research. The correlation between diabetes and kidney disease is not merely coincidental. Diabetes is recognized as a significant risk factor for CKD, as individuals with diabetes are considerably more vulnerable to developing renal complications. Diabetic nephropathy, a distinct type of kidney disease closely associated with diabetes, is a significant factor in developing end-stage renal disease. It is imperative to implement efficient diabetes management strategies to regulate blood sugar levels and prevent potential kidney damage. On the other hand, kidney disease may contribute to the development of diabetes. The kidneys regulate glucose levels by filtering the blood and selectively reabsorbing glucose as necessary. In compromised kidney function, such as CKD, impaired glucose metabolism can give rise to insulin resistance and diabetes. As a result, the management of kidney disease plays a dual role in both preserving renal function and preventing diabetes in individuals who are at risk. The coexistence of diabetes and kidney disease in a patient presents complex clinical challenges. Achieving effective management requires a meticulous balance between glycemic control and preservation of renal function. Failing to maintain this delicate equilibrium can lead to cardiovascular complications and subsequent hospitalizations. This comprehensive narrative review aims to thoroughly examine the pathophysiological mechanisms that connect diabetes and kidney disease. It will provide insights into the clinical manifestations and diagnostic methods, explore various approaches to managing the condition, discuss the crucial role of nutrition, delve into pharmacological interventions, emphasize the importance of patient education and self-care, and shed light on emerging research areas. In addition to impacting individual health outcomes, this reciprocal relationship has significant implications for healthcare systems, socioeconomic landscapes, and public health policy. Comprehending this complex interaction is crucial for making well-informed clinical judgments, improving patient care, and developing a more efficient public health approach to address the interconnected issues of diabetes and kidney disease.

Sodium-glucose cotransporter-2 inhibitor use in kidney transplant recipients.

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are novel oral hypoglycemic agents garnering much attention for their substantial benefits. These recent data have positioned SGLT2i at the forefront of diabetic chronic kidney disease (CKD) and heart failure management. SGLT2i use post-kidney transplant is an emerging area of research. Highlights from this mini review include the following: Empagliflozin is the most prescribed SGLT2i in kidney transplant recipients (KTRs), median time from transplant to initiation was 3 years (range: 0.88-9.6 years). Median baseline estimated glomerular filtration rate (eGFR) was 66.7 mL/min/1.73 m2 (range: 50.4-75.8). Median glycohemoglobin (HgbA1c) at initiation was 7.7% (range: 6.9-9.3). SGLT2i were demonstrated to be effective short-term impacting HgbA1c, eGFR, hemoglobin/hematocrit, serum uric acid, and serum magnesium levels. They are shown to be safe in KTRs with low rates of infections, hypoglycemia, euglycemic diabetic ketoacidosis, and stable tacrolimus levels. More data is needed to demonstrate long-term outcomes. SGLT2i appear to be safe, effective medications for select KTRs. Our present literature, though limited, is founded on precedent robust research in CKD patients with diabetes. Concurrent research/utilization of SGLT2i is vital to not only identify long-term patient, graft and cardiovascular outcomes of these agents, but also to augment management in KTRs.

Efficacy of comprehensive group-based education in lowering body weight, uric acid levels, and diuretic use in patients with chronic kidney disease: a retrospective study

BackgroundPatient education for the management of chronic kidney disease (CKD) is attracting attention. Therefore, this study aimed to analyze changes in body weight, uric acid, and estimated-glomerular filtration rate (eGFR) in patients with CKD after a group-based education during admission.MethodsOverall, 157 patients with CKD, who were discharged from the nephrology department of our hospital between January 2015 and October 2019, received group-based education or individual-based education by nurses at admission. Deltas of body weight, uric acid, and eGFR, 6 months from baseline, were compared between group- and individual-based education using the Wilcoxon rank sum test.ResultsIn total, 60 patients receiving group-based education (G group, n =35) or individual-based education (I group, n =25) during admission were included in this retrospective study. The patient characteristics at baseline were as follows: age mean, 72 ± SD 9; 16 females and 44 males; body weight, 62 ± 17 kg; eGFR median, 21 (IQR: 14, 29) mL/min/1.73 m2; UA, 7 (6.1, 7.5) mg/dL; and estimated intake of salt 6.9 (6.2, 8.4) g/day. Delta eGFR (mL/min/1.73 m2) was -1 (-3, 3) for G group and -1 (-2.5, 2) for I group (p = 0.8039). Delta body weight (kg) was -0.4 (-1.6, 0) for G group and 0 (-0.45, 0.95) for I group (p = 0.0597). Delta uric acid (mg/dL) was -1.1 (-1.6, 0.1) for G group and -0.2 (-1.1, 0.5) for I group (p = 0.0567).In patients with higher sodium intake (≥ 117.4 mEq/day), delta body weight was significantly lower in the group-based education group than in the individual-based education group (p = 0.0398).ConclusionsA comprehensive group-based education in patients with CKD may effectively suppress body weight and uric acid in 6 months along with less frequent diuretic use.

Application of Bioelectrical Impedance Analysis in Nutritional Management of Patients with Chronic Kidney Disease.

Body composition measurement plays an important role in the nutritional diagnosis and treatment of diseases. In the past 30 years, the detection of body composition based on bioelectrical impedance analysis (BIA) has been widely used and explored in a variety of diseases. With the development of technology, bioelectrical impedance analysis has gradually developed from single-frequency BIA (SF-BIA) to multi-frequency BIA (multi-frequency BIA, MF-BIA) and over a range of frequencies (bioimpedance spectroscopy, BIS). As the clinical significance of nutrition management in chronic kidney disease has gradually become prominent, body composition measurement by BIA has been favored by nephrologists and nutritionists. In the past 20 years, there have been many studies on the application of BIA in patients with CKD. This review describes and summarizes the latest research results of BIA in nutritional management of patients with CKD including pre-dialysis, hemodialysis, peritoneal dialysis and kidney transplantation, in order to provide reference for the application and research of BIA in nutritional management of chronic kidney disease in the future.

Downregulation of ARNTL in renal tubules of diabetic db/db mice reduces kidney injury by inhibiting ferroptosis

BackgroundThe prevalence of ferroptosis in diabetic kidney tubules has been documented, yet the underlying mechanism remains elusive. The aim of this study was to ascertain the pivotal gene linked to ferroptosis and establish a novel target for the prevention and management of diabetic kidney disease (DKD). MethodsTranscriptomics data (GSE184836) from DKD mice (C57BLKS/J) were retrieved from the GEO database and intersected with ferroptosis-related genes from FerrDb. Then, differentially expressed genes associated with ferroptosis in the glomeruli and tubules were screened. Gene ontology analysis and protein-protein interaction network construction were used to identify key genes. Western blotting and real-time quantitative polymerase chain reaction were employed to validate the expression in the same model. Aryl hydrocarbon receptor nuclear translocator-like protein 1 (ARNTL) expression in patients and mice with DKD was assessed using immunohistochemistry staining. ARNTL knockdown in C57BLKS/J mice was established and plasma malonaldehyde, superoxide dismutase, and renal pathology were analyzed. The efficacy of ARNTL knockdown was evaluated using proteomics analysis. Mitochondrial morphology was observed using transmission electron microscopy. ResultsARNTL was screened by bioinformatics analysis and its overexpression verified in patients and mice with DKD. ARNTL knockdown reduced oxidative stress in plasma. Kidney proteomics revealed that ferroptosis was inhibited. The reduction of the classic alteration in mitochondrial morphology associated with ferroptosis was also observed. Gene set enrichment analysis demonstrated that the downregulation of the TGFβ pathway coincided with a decrease in collagen protein and TGFβ1 levels. ConclusionsThe ferroptosis-associated gene ARNTL is a potential target for treating DKD.

Nutrition and Metabolism for Kidney Health and Disease Management: 45 years of Development and Future Directions Under the International Society of Renal Nutrition and Metabolism

Nutrition and Metabolism for Kidney Health and Disease Management: 45 years of Development and Future Directions Under the International Society of Renal Nutrition and Metabolism

Actual dietary intake versus dietary recommendation among patients with chronic kidney disease!-an observational study

Background: As diet is an important component of chronic kidney disease management. It is important to understand the actual dietary intake of these patients and see if they are able to meet their respective recommended dietary allowance (RDA), failing which they are predisposed to malnutrition. Hence the study was carried out to assess the actual dietary intake of the subjects with chronic kidney disease to understand the gap between recommendation and actual intake. Aim of this study was to assess the dietary intake of patients with chronic kidney disease. Methods: Patients with chronic kidney disease in stages 3 and 4 were recruited based on the inclusion criteria and the information on demographics, medical history, subjective data and seven-day dietary recall were obtained. The quantitative and qualitative estimation of the seven-day dietary intake was computed using “Dietcal” software. Results: Anorexia was observed among 54% of the study participants. The mean calorie, protein and carbohydrate intake was 959.69±166.49 Kcals, 27.94±5.36 g and 160.5±26.7 g respectively while mean intake of sodium, potassium and phosphorous were 88.65±42.88 mg, 944.5±188.69 mg and 560.77±127.64 mg respectively. Conclusions: The actual dietary intake was lesser than the recommended intake as influenced by anorexia, dysguesia, early satiety and dietary restrictions. Poor nutrient intake per se is the primary influential factor in the onset of malnutrition. Hence, it is important to adopt customized approach rather than generalized nutrient restrictions imposed upon these patients.

Psoralen Alleviates Renal Fibrosis by Attenuating Inflammasome-Dependent NLRP3 Activation and Epithelial-Mesenchymal Transition in a Mouse Unilateral Ureteral Obstruction Model.

The role of psoralen (PS), a major active component extracted from Psoralea corylifolia L. seed, in renal fibrosis is still unclear. Thus, the objective of this study was to evaluate the effects of PS on the development and progression of renal fibrosis induced by unilateral ureteral obstruction (UUO) in a mouse model. Mice were divided into four groups: PS (20 mg/kg, i.g., n = 5), PS + sham (n = 5), UUO (n = 10), and PS + UUO (n = 10). PS was intragastrically administered 24 h before UUO and continued afterwards for 7 days. All mice were killed 7 days post UUO. Severe tubular atrophy, tubular injury, and tubulointerstitial fibrosis (TIF) were significantly developed in UUO mice. A higher expression of transforming growth factor-β1 (TGF-β1) was accompanied by elevated levels of α-smooth muscle actin (α-SMA) and phosphorylated Smad2/3 (pSmad2/3) at 7 days post UUO. However, PS treatment reduced tubular injury, interstitial fibrosis, and the expression levels of TGF-β1, α-SMA, and pSmad2/3. Furthermore, the levels of macrophages (represented by F4/80 positive cells) and the inflammasome, reflected by inflammasome markers such as nucleotide-binding and oligomerization domain-like receptors protein 3 (NLRP3) and cleaved caspase1 (cCASP-1), were significantly decreased by PS treatment. These results suggest that PS merits further exploration as a therapeutic agent in the management of chronic kidney disease (CKD).

Why do we keep ignoring sex in kidney disease?

Throughout the history of nephrology, little attention has been paid to the sex and gender differences in kidney disease. This lack of awareness prevents optimal diagnosis and management of kidney disease. In today's world of precision medicine, it is imperative to appreciate the differential factors regarding gender and kidney disease. This editorial summarizes the up-to-date literature regarding sex and gender differences in kidney disease and considers areas where knowledge is incomplete and where further research is needed. We address sex-specific effects on chronic kidney disease epidemiology; risks of dialysis underdosing and medication overdosing in women; unexplained loss of female sex advantage in life expectancy during dialysis, and impact of sex on diagnosis and management of genetic kidney disease. We also aim to highlight the impact of gender on kidney health and raise awareness of disparities that may be faced by women, and transgender and gender-diverse persons when a male-model approach is used by healthcare systems. By understanding the link between sex and kidney disease, kidney specialists can improve the care and outcomes of their patients. In addition, research on this topic can inform the development of targeted prevention and intervention strategies that address the specific needs and risk factors of different populations.

Guidelines for the early evaluation and management of chronic kidney disease in China

Chronic kidney disease (CKD) has become a serious public health concern that endangers human health on a global scale. In China, the prevalence of CKD in adults is 10.8%; however, public awareness and the diagnostic rates of CKD in the Chinese population are relatively low. Moreover, China has not yet established a national CKD screening system or developed standardized diagnostic protocols and treatment pathways. Therefore, there is an urgent need to strengthen the prevention and control of CKD and promote the management of this disease. These guidelines were initiated by the Chinese Preventive Medicine Association for Kidney Disease. The quality of evidence and guideline recommendation were determined by applying the Oxford Centre for Evidence-Based Medicine (CEBM) System. These new guidelines describe 38 recommendations that aim to standardize the early screening, management, diagnosis and treatment of CKD, thus promoting the integrated prevention and control of kidney disease in China.